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PubMed2003

Comparison of pathologist-detected and automated computer-assisted image analysis detected sentinel lymph node micrometastases in breast cancer.

Sentinel lymph node biopsy has stimulated interest in identification of micrometastatic disease in lymph nodes, but identifying small clusters of tumor cells or single tumor cells in lymph nodes can be tedious and inaccurate. The optimal method of detecting micrometastases in sentinel nodes has not been established. Detection is dependent on node sectioning strategy and the ability to locate and confirm tumor cells on histologic sections. Immunohistochemical techniques have greatly enhanced detection in histologic sections; however, comparison of detection methodology has not been undertaken. Automated computer-assisted detection of candidate tumor cells may have the potential to significantly assist the pathologist. This study compares computer-assisted micrometastasis detection with routine detection by a pathologist. Cytokeratin-stained sentinel lymph node sections from 100 patients at the University of Vermont were evaluated by automated computer-assisted cell detection. Based on original routine light microscopy screening, 20 cases that were positive and 80 cases that were negative for micrometastases were selected. One-level (43 cases) or two-level (54 cases) cytokeratin-stained sections were examined per lymph node block. All 100 patients had previously been classified as node negative by using routine hematoxylin and eosin stained sections. Technical staining problems precluded computer-assisted cell detection scanning in three cases. Computer-assisted cell detection detected 19 of 20 (95.0%; 95% confidence interval, 75-100%) cases positive by routine light microscopy. Micrometastases missed by computer-assisted cell detection were caused by cells outside the instrument's scanning region. Computer-assisted cell detection detected additional micrometastases, undetected by light microscopy, in 8 of 77 (10.4%; 95% confidence interval, 5-20%) cases. The computer-assisted cell detection-positive, light microscopy-missed detection rate was similar for cases with one (3 of 30; 10.0%) or two (5 of 47; 10.6%) cytokeratin sections. Metastases detected by routine light microscopy tended to be larger (0.01-0.50 mm) than did metastases detected only by computer-assisted cell detection (0.01-0.03 mm). In a selected series of patients, automated computer-assisted cell detection identified more micrometastases than were identified by routine light microscopy screening of cytokeratin-stained sections. Computer-assisted detection of events that are limited in number or size may be more reliable than detection by a pathologist using routine light microscopy. Factors such as human fatigue, incomplete section screening, and variable staining contribute to missing metastases by routine light microscopy screening. Metastases identified exclusively by computer-assisted cell detection tend to be extremely small, and the clinical significance of their identification is currently unknown.

Breast Neoplasms↗
PubMed1994

Computer education: attitudes and opinions of first-year medical students.

Students' attitudes toward medical informatics were evaluated with self-administered questionnaires, answered by 140 (77%) first-year medical and dental students. Fourteen per cent classified their computer literacy as negligible and 49% as deficient. Ninety-six per cent had used a computer before and 59% used one regularly. Nineteen per cent had computer education in secondary school and a further 16% attended courses given by a computer company. Only 16% read regularly about informatics. These results are similar to those observed in more industrialized countries, except that high-school education is more deficient. To 93% of these students, computer literacy is important for doctors, and to 85% computers may be very useful in many areas of health care. In the opinion of 66% of students, the computer-based patient record will be available within the next 3 to 10 years. Women showed lesser computer literacy (77% computer illiteracy to 39% in men), but there were no relevant differences in attitudes, behaviour and beliefs towards medical informatics between gender, for the same level of computer literacy. Computer education in the undergraduate curriculum was demanded by 92%, and 75% of these preferred an elective course. Weekly hours suggested for lectures should be 1 (54%) or 2 (42%), and for hands-on practice 2 (54%) or 4 (31%) hours. The curriculum should include medical applications (83% of students), information science theory and technology (44%), micro-informatics (44%), bibliographic database search (27%), programming languages (23%) and statistical packages (23%). Gender, computer literacy or course did not correlate significantly with students' opinions about the contents of undergraduate education.

Attitude of Health Personnel↗
PubMed1989

Comparison of magnetic resonance imaging and computed tomography in suspected lesions in the posterior cranial fossa.

OBJECTIVE: To compare computed tomography and magnetic resonance imaging in investigating patients suspected of having a lesion in the posterior cranial fossa. DESIGN: Randomised allocation of newly referred patients to undergo either computed tomography or magnetic resonance imaging; the alternative investigation was performed subsequently only in response to a request from the referring doctor. SETTING: A regional neuroscience centre serving 2.7 million. PATIENTS: 1020 Patients recruited between April 1986 and December 1987, all suspected by neurologists, neurosurgeons, or other specialists of having a lesion in the posterior fossa and referred for neuroradiology. The groups allocated to undergo computed tomography or magnetic resonance imaging were well matched in distributions of age, sex, specialty of referring doctor, investigation as an inpatient or an outpatient, suspected site of lesion, and presumed disease process; the referring doctor's confidence in the initial clinical diagnosis was also similar. INTERVENTIONS: After the patients had been imaged by either computed tomography or magnetic resonance (using a resistive magnet of 0.15 T) doctors were given the radiologist's report and a form asking if they considered that imaging with the alternative technique was necessary and, if so, why; it also asked for their current diagnoses and their confidence in them. MAIN OUTCOME MEASURES: Number of requests for the alternative method of investigation. Assessment of characteristics of patients for whom further imaging was requested and lesions that were suspected initially and how the results of the second imaging affected clinicians' and radiologists' opinions. RESULTS: Ninety three of the 501 patients who initially underwent computed tomography were referred subsequently for magnetic resonance imaging whereas only 28 of the 493 patients who initially underwent magnetic resonance imaging were referred subsequently for computed tomography. Over the study the number of patients referred for magnetic resonance imaging after computed tomography increased but requests for computed tomography after magnetic resonance imaging decreased. The reason that clinicians gave most commonly for requesting further imaging by magnetic resonance was that the results of the initial computed tomography failed to exclude their suspected diagnosis (64 patients). This was less common in patients investigated initially by magnetic resonance imaging (eight patients). Management of 28 patients (6%) imaged initially with computed tomography and 12 patients (2%) imaged initially with magnetic resonance was changed on the basis of the results of the alternative imaging. CONCLUSIONS: Magnetic resonance imaging provided doctors with the information required to manage patients suspected of having a lesion in the posterior fossa more commonly than computed tomography, but computed tomography alone was satisfactory in 80% of cases...

Brain Diseases↗
PubMedDate not supplied

The impact of home computer use on children's activities and development.

The increasing amount of time children are spending on computers at home and school has raised questions about how the use of computer technology may make a difference in their lives--from helping with homework to causing depression to encouraging violent behavior. This article provides an overview of the limited research on the effects of home computer use on children's physical, cognitive, and social development. Initial research suggests, for example, that access to computers increases the total amount of time children spend in front of a television or computer screen at the expense of other activities, thereby putting them at risk for obesity. At the same time, cognitive research suggests that playing computer games can be an important building block to computer literacy because it enhances children's ability to read and visualize images in three-dimensional space and track multiple images simultaneously. The limited evidence available also indicates that home computer use is linked to slightly better academic performance. The research findings are more mixed, however, regarding the effects on children's social development. Although little evidence indicates that the moderate use of computers to play games has a negative impact on children's friendships and family relationships, recent survey data show that increased use of the Internet may be linked to increases in loneliness and depression. Of most concern are the findings that playing violent computer games may increase aggressiveness and desensitize a child to suffering, and that the use of computers may blur a child's ability to distinguish real life from simulation. The authors conclude that more systematic research is needed in these areas to help parents and policymakers maximize the positive effects and to minimize the negative effects of home computers in children's lives.

Adolescent↗
PubMed2005

The prevalence of computer-related musculoskeletal complaints in female college students.

PURPOSE: The purpose of this study was to determine the prevalence of computer-related musculoskeletal complaints in female college students. This research also explored whether the number of hours per day spent using a computer, type of computer used (laptop vs. desktop), or academic major was related to the presence of musculoskeletal complaints. Additionally, "job strain", a measure of job stress which can affect the physical health of an individual, was measured to determine whether students feel stress from the job of "student" and if so, whether it contributed to these complaints. METHODS: Two surveys, The Boston University Computer and Health Survey and the Job Content Questionnaire [9], were distributed to 111 female college students to measure musculoskeletal complaints and job strain. Seventy-two surveys were returned. Chi-square and logistical regression were used to analyze the data. RESULTS: The results indicated that 80.6% of the participants reported computer-related musculoskeletal complaints in the two weeks prior to completing the survey, although none of the examined factors were associated with the complaints. It is notable, however, that 82% of the students reported spending 0-6 hours/day using a computer, with almost 28% reporting 4-6 hours/day of usage. Eleven percent of the participants reported using the computer more than 8 hours/day. Of those students who use a laptop computer for all computer use, 90.1% reported musculoskeletal complaints. The students reported that they did not experience job strain. Further studies should be performed using a survey specifically intended for college students. CONCLUSION: The majority of female college students in this study reported musculoskeletal discomfort during or after computer use. Although a statistical correlation could not be made, students using laptop computers reported a higher incidence of musculoskeletal symptoms than those using desktop computers. Additionally, female college students did not seem to experience job strain. Future research should continue on larger, more diverse samples of students to better understand the prevalence and contributors of musculoskeletal complaints, how college students experience job strain (stress), and whether these two factors are related.

Adult↗
PubMed2003

Validation of a computer-based colonoscopy simulator.

BACKGROUND: The computer-based colonoscopy simulator is intended to provide a realistic colonoscopic experience and feedback to operators regarding procedure skills. Advocates hope that computer-based colonoscopy simulators will enhance the mastery of colonoscopy by trainees. Before this hypothesis can be tested, the claims made for a simulator must be validated. The aims of this study were to answer the following: Does a computer-based colonoscopy simulator provide a "realistic" experience? Do computer-based colonoscopy simulators' performance parameters differentiate varying levels of experience? METHODS: Ten staff gastroenterologists, 6 gastroenterology fellows, and 6 residents each performed 2 computer-based colonoscopy simulator colonoscopies and performance parameters were recorded. Staff colonoscopists then completed a 6-item survey grading the "realism" of the simulation and procedure difficulty. Survey responses and performance scores were compared with the Wilcoxon rank-sum test. RESULTS: Faculty found the computer-based colonoscopy simulator experience to be realistic despite the "cases" being markedly easier than actual colonoscopy. The computer-based colonoscopy simulator distinguishes subjects according to endoscopic experience with 3 of its measured parameters (total procedure time, insertion time, time in "red-out"). No significant difference in the ability to distinguish among user types was found for the other 10 computer-based colonoscopy simulator measurements for which data were analyzable. CONCLUSION: The computer-based colonoscopy simulator provides a favorable degree of virtual realism with regard to visual simulation and colonoscope mechanics, although the "cases" were regarded as considerably easier than actual colonoscopy. The computer-based colonoscopy simulator has only limited capability for distinguishing varying levels of competence at actual colonoscopy. These findings suggest that a study to determine the role of computer-based colonoscopy simulators in the curriculum of trainees is warranted.

Clinical Competence↗
PubMed2001

Computer-assisted learning in critical care: from ENIAC to HAL.

Computers are commonly used to serve many functions in today's modern intensive care unit. One of the most intriguing and perhaps most challenging applications of computers has been to attempt to improve medical education. With the introduction of the first computer, medical educators began looking for ways to incorporate their use into the modern curriculum. Prior limitations of cost and complexity of computers have consistently decreased since their introduction, making it increasingly feasible to incorporate computers into medical education. Simultaneously, the capabilities and capacities of computers have increased. Combining the computer with other modern digital technology has allowed the development of more intricate and realistic educational tools. The purpose of this article is to briefly describe the history and use of computers in medical education with special reference to critical care medicine. In addition, we will examine the role of computers in teaching and learning and discuss the types of interaction between the computer user and the computer.

Computer Simulation↗
PubMed2004

Study of basic computer competence among public health nurses in Taiwan.

Rapid advances in information technology and media have made distance learning on the Internet possible. This new model of learning allows greater efficiency and flexibility in knowledge acquisition. Since basic computer competence is a prerequisite for this new learning model, this study was conducted to examine the basic computer competence of public health nurses in Taiwan and explore factors influencing computer competence. A national cross-sectional randomized study was conducted with 329 public health nurses. A questionnaire was used to collect data and was delivered by mail. Results indicate that basic computer competence of public health nurses in Taiwan is still needs to be improved (mean = 57.57 +- 2.83, total score range from 26-130). Among the five most frequently used software programs, nurses were most knowledgeable about Word and least knowledgeable about PowerPoint. Stepwise multiple regression analysis revealed eight variables (weekly number of hours spent online at home, weekly amount of time spent online at work, weekly frequency of computer use at work, previous computer training, computer at workplace and Internet access, job position, education level, and age) that significantly influenced computer competence, which accounted for 39.0 % of the variance. In conclusion, greater computer competence, broader educational programs regarding computer technology, and a greater emphasis on computers at work are necessary to increase the usefulness of distance learning via the Internet in Taiwan. Building a user-friendly environment is important in developing this new media model of learning for the future.

Adult↗
PubMed2002

Promise and challenge of high-performance computing, with examples from molecular modelling.

Computational modelling is one of the most significant developments in the practice of scientific inquiry in the 20th century. During the past decade, advances in computing technologies have increased the speed of computers by a factor of 100; an increase of a factor of 1000 can be expected in the next decade. These advances have, however, come at a price, namely, radical change(s) in computer architecture. Will computational scientists and engineers be able to harness the power offered by these high-performance computers to solve the most critical problems in science and engineering? In this paper, we discuss the challenges that must be addressed if we are to realize the benefits offered by high-performance computing. The task will not be easy; it will require revision or replacement of much of the software developed for vector supercomputers as well as advances in a number of key theoretical areas. Because of the pace of computing advances, these challenges must be met by close collaboration between computational scientists, computer scientists and applied mathematicians. The effectiveness of such a multidisciplinary approach is illustrated in a brief review of NWCHEM, a general-purpose computational chemistry code designed for parallel supercomputers.

Algorithms↗
PubMed1997

Computer awareness among medical students: a survey.

The objective of the study was to assess the attitude of Edinburgh University medical students towards computers and to evaluate the effects of changes in the curriculum and intercalated BSc towards computer knowledge. During March to November 1995 a questionnaire was distributed in lectures, seminars and tutorials to all Edinburgh University medical students. Overall, 65% of students returned the questionnaire, divided equally between both genders. Only 2% of students had not used a computer in the previous year. The most frequent application used was E-mail and the most frequent site, the Greenfield suite micro lab, within the medical school. The average score for self-perceived computer knowledge on a scale of 0-10 was 4.19. This score was significantly higher for the students who own a computer and who have an intercalated BSc honours degree as well as the pre-clinical students compared to the clinical students. There is also a strong correlation between computer use and doing a second year special option module. With regards to attitude towards computers, 86% of students agreed that computer skills will be beneficial to them in their future career and 62% of all students wanted a structured course in computer use as part of the MB ChB course. There has been a general increase in computer literacy amongst the medical students in Edinburgh. This is specially so for the pre-clinical students who have had the brunt of the changes in the curriculum. The tendency for both the lower knowledge and use by the clinical students can, in part, be due to the accessibility of computers to these students.

Attitude to Computers↗
PubMed2004

Validation and patient acceptance of a computer touch screen version of the WOMAC 3.1 osteoarthritis index.

OBJECTIVES: To validate the WOMAC 3.1 in a touch screen computer format, which applies each question as a cartoon in writing and in speech (QUALITOUCH method), and to assess patient acceptance of the computer touch screen version. METHODS: The paper and computer formats of WOMAC 3.1 were applied in random order to 53 subjects with hip or knee osteoarthritis. The mean age of the subjects was 64 years (range 45 to 83), 60% were male, 53% were 65 years or older, and 53% used computers at home or at work. Agreement between formats was assessed by intraclass correlation coefficients (ICCs). Preferences were assessed with a supplementary questionnaire. RESULTS: ICCs between formats were 0.92 (95% confidence interval, 0.87 to 0.96) for pain; 0.94 (0.90 to 0.97) for stiffness, and 0.96 (0.94 to 0.98) for function. ICCs were similar in men and women, in subjects with or without previous computer experience, and in subjects below or above age 65. The computer format was found easier to use by 26% of the subjects, the paper format by 8%, and 66% were undecided. Overall, 53% of subjects preferred the computer format, while 9% preferred the paper format, and 38% were undecided. CONCLUSION: The computer format of the WOMAC 3.1 is a reliable assessment tool. Agreement between computer and paper formats was independent of computer experience, age, or sex. Thus the computer format may help improve patient follow up by meeting patients' preferences and providing immediate results.

Adult↗
PubMed2002

Scalable hybrid computation with spikes.

We outline a hybrid analog-digital scheme for computing with three important features that enable it to scale to systems of large complexity: First, like digital computation, which uses several one-bit precise logical units to collectively compute a precise answer to a computation, the hybrid scheme uses several moderate-precision analog units to collectively compute a precise answer to a computation. Second, frequent discrete signal restoration of the analog information prevents analog noise and offset from degrading the computation. And, third, a state machine enables complex computations to be created using a sequence of elementary computations. A natural choice for implementing this hybrid scheme is one based on spikes because spike-count codes are digital, while spike-time codes are analog. We illustrate how spikes afford easy ways to implement all three components of scalable hybrid computation. First, as an important example of distributed analog computation, we show how spikes can create a distributed modular representation of an analog number by implementing digital carry interactions between spiking analog neurons. Second, we show how signal restoration may be performed by recursive spike-count quantization of spike-time codes. And, third, we use spikes from an analog dynamical system to trigger state transitions in a digital dynamical system, which reconfigures the analog dynamical system using a binary control vector; such feedback interactions between analog and digital dynamical systems create a hybrid state machine (HSM). The HSM extends and expands the concept of a digital finite-state-machine to the hybrid domain. We present experimental data from a two-neuron HSM on a chip that implements error-correcting analog-to-digital conversion with the concurrent use of spike-time and spike-count codes. We also present experimental data from silicon circuits that implement HSM-based pattern recognition using spike-time synchrony. We outline how HSMs may be used to perform learning, vector quantization, spike pattern recognition and generation, and how they may be reconfigured.

Action Potentials↗
PubMed2004

Computation of elementary modes: a unifying framework and the new binary approach.

BACKGROUND: Metabolic pathway analysis has been recognized as a central approach to the structural analysis of metabolic networks. The concept of elementary (flux) modes provides a rigorous formalism to describe and assess pathways and has proven to be valuable for many applications. However, computing elementary modes is a hard computational task. In recent years we assisted in a multiplication of algorithms dedicated to it. We require a summarizing point of view and a continued improvement of the current methods. RESULTS: We show that computing the set of elementary modes is equivalent to computing the set of extreme rays of a convex cone. This standard mathematical representation provides a unified framework that encompasses the most prominent algorithmic methods that compute elementary modes and allows a clear comparison between them. Taking lessons from this benchmark, we here introduce a new method, the binary approach, which computes the elementary modes as binary patterns of participating reactions from which the respective stoichiometric coefficients can be computed in a post-processing step. We implemented the binary approach in FluxAnalyzer 5.1, a software that is free for academics. The binary approach decreases the memory demand up to 96% without loss of speed giving the most efficient method available for computing elementary modes to date. CONCLUSIONS: The equivalence between elementary modes and extreme ray computations offers opportunities for employing tools from polyhedral computation for metabolic pathway analysis. The new binary approach introduced herein was derived from this general theoretical framework and facilitates the computation of elementary modes in considerably larger networks.

Algorithms↗
PubMed1992

[Computers in urology].

The present state of computer utilization in urology has been described. Nowadays, use of computer is becoming essential in the urological diagnosis and treatment. Recently computers have been so rapidly developed so that it became much smaller and yet offers higher performance. The methods and problems of utilizing computers have been explained by presenting actual examples. An important point that must be recognized in utilizing computers is that the computer is meant to be a part of method in resolving problems and its use itself is not conclusion. In other words, computers are a means of methodology. Computers have been used for frequency analysis in urophonograms, diagnosis in a simultaneous pressure-flow study in lower urinary tract, and for supporting the data entry by photoscanner. Moreover, computers have been used for digital differentiation to materialize higher performance uroflowmeter. Computers have also been applied to litholytic fluid pressure-flow control system for renal stones, and played important role in long hours's intra pelvic pressure monitoring system in support of the large amount of data accumulation and noise reduction. Recently, in the expert system in the pressure-flow study etc., computer plays an essential role which covers most territory of the system. Finally, its future applications have also been speculated.

Computers↗
PubMed1998

3D-brain 2.0--narrowing the gap between personal computers and high end workstations.

UNLABELLED: Recent advances in personal computer hardware and software have pushed the graphic capacity of these easier to use and, more importantly, cheaper computers to a level approximating the current standard of high end workstations. The interactivity and graphic complexity of a modern PC is rapidly approaching the current standard on Silicon Graphics (although with respect to texture mapping, the SGI is still ahead of the PCs). The modern medical student laboring under increasingly higher demands with respect to versatility, not only in basic science and traditional medical knowledge, is also faced with the requirement to learn and understand modern scientific visualization and analytical instruments. Furthermore, basic knowledge of information technology and computer literacy is expected of the next generation medical professionals. These demands forces medical schools to increasingly invest in computers and information technology for educational purposes. Due to common class sizes, these computers are most commonly Windows PCs or Apple Macintoshes. For distance education, telematics or studies at home, personal computer versions of the workstation graphics are a necessity. 3D-Brain 2.0 is an educational software package intended to run on basic personal computers and utilizing modern software technologies such as QuickTime VR 2.0 and VRML 2.0, to provide the students with insight into modern clinical and scientific visualization, focusing on the anatomy and functionality of the human brain. The aim of this paper to test the validity and usefulness of these new visualization techniques. METHODS: 3D-Brain is based on human brains sliced in 1 mm sections (NB. NOT based on NLMs Visual Human). Each slice was photographed, digitized, optimized and aligned using proprietary software. The datasets were then created by manual tracing followed by triangulation, smoothing and 3D visualization using Silicon Graphics computers. For the QuickTime VR project, 684 images with a 10 degrees angle were generated for each scene and ported to an Apple Macintosh computer for further manipulation. VRML code was generated directly from the original dataset. All interactivity was programmed on a Macintosh and subsequently ported to the Windows95 PC platform. The minimum requirements to run the software are either a PowerPC based Macintosh computer or a Pentium based Windows 95 computer with 16 Mb, 16 bit display and a 4 speed CD-ROM. RESULTS AND DISCUSSION: 3D-Brain 2.0 provides medical students at Goteborg University the means to complement traditional teaching using visualization techniques and three-dimensional models. These techniques also serve as an insight into the different clinical means of visualization the student will encounter throughout his/her continued education and professional career. For educational purposes, it has been established that among the tested new visualization techniques, CD-ROM based software utilizing QTVR is still the best methodology to use for pedagogical software. VRML shows promise in porting these software packages to the Web while Open Inventor is the preferred format for research purposes.

Brain↗
PubMed2004

Does computation provide a model for creativity? An epistemological perspective in neuroscience.

In 1939 Alan Turing, a major scholar in the field of mechanical computation, described a system whose computational power was beyond that of a discrete, finite state machine (Turing Machine). The composition of this system was likely the first example of what is now called an hybrid computational system. Since then, development of neural networks and brain automata has made aware that forms of computation might exist that are likely to go beyond Turing's limits. Natural systems, like the central nervous system in Mammals and man, are likely to use such a type of computation, especially to perform highly integrating activities, like feedback controls and mental creative processes. The latter are usually understood as processes that involve infinitary procedures, ending up in a complex information network, the computational maps, in which both digital, Turing-like computation and continuous, analog forms of calculus are expected to occur. Pictorial representation may be a fruitful example, mostly metaphorical, to analyze the use of this hybrid forms of computation by higher order computational maps, and the possible role of these types of computational processes in painting creativity is briefly analyzed in comparing 15th vs 16th century Renaissance Art. An open challenge for neuroscience in the 21st century is to clarify whether a hybrid neural learning network might represent a reasonable clue to scientifically interpret the theme of "creativity".

Art↗
PubMed2002

The association between children's computer use and musculoskeletal discomfort.

UNLABELLED: As American children spend more time working at computers, they may be putting themselves at risk for musculoskeletal disorders and other conditions that can result from overuse. There is little research that describes the home computer use of American middle school children or that describes the prevalence of musculoskeletal discomfort in this population. This study provides a general description of the computer set-up and home use of 152 6th grade children and looks at the association between overall musculoskeletal discomfort and various ergonomic variables. METHOD: 152 6th grade children completed the Musculoskeletal Discomfort Questionnaire and a survey of home computer use. RESULTS: More than half of the children reported some musculoskeletal discomfort within the last year. This pain could be made worse by computer use. Students reported that they had three computers in their house, and that they generally did not have furniture specifically designed for computer use. There was a significant association between the number of hours on the computer and overall musculoskeletal discomfort (r = 0.19, p = 0.05). The odds ratios between having furniture designed for the computer and touch typing and musculoskeletal discomfort were borderline significant, but suggested that students without proper furniture were more likely to have musculoskeletal discomfort (OR = 1.89, 95% CI = 0.94-3.84) and that those who could touch type were less likely to have musculoskeletal discomfort (OR = 0.54, 95%, CI = 0.26-1.10), OR). CONCLUSION: American children are reporting moderate amounts of musculoskeletal discomfort and this discomfort can be associated with computer use. Risk factors associated with computer use and discomforts are similar to those reported in the adult literature. Further study is necessary to understand the similarities and differences between adult and children computer use and how to protect both from developing musculoskeletal discomfort.

Child↗
PubMed2000

Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients.

We performed a randomised controlled study to assess the accuracy of computer-assisted pedicle screw insertion versus conventional screw placement under clinical conditions. One hundred patients scheduled for posterior thoracolumbar or lumbosacral pedicle screw instrumentation were randomised into two groups, either for conventional pedicle screw placement or computer-assisted screw application using an optoelectronic navigation system. From the computer-assisted group, nine patients were excluded: one because of an inadequate preoperative computed tomography study, seven because of problems with the specific instruments or the computer system, and one because of an intraoperative anesthesiological complication. Thus, there were 50 patients in the conventional group and 41 in the computer-assisted group, and the number of screws inserted was 277 and 219, respectively. There was no statistical difference between the groups concerning age, gender, diagnosis, type of operation performed, mean operating time, blood loss, or number of screws inserted. The time taken for screw insertion was significantly longer in the computer-assisted group. Postoperatively, screw positions were assessed by an independent radiologist using a sophisticated CT imaging protocol. The pedicle perforation rate was 13.4% in the conventional group and 4.6% in the computer-assisted group (P = 0.006). Pedicle perforations of more than 4 mm were found in 1.4% (4/277) of the screw insertions in the conventional group, and none in the computer-assisted group. Complications not related to pedicle screws were two L5 nerve root lesions, one end plate fracture, one major intraoperative bleeding and one postoperative death in the conventional group, and one deep infection in the computer-assisted group. In conclusion, pedicular screws were inserted more accurately with image-guided computer navigation than with conventional methods.

Adult↗