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PubMed1993

Computer use in private dental practice in Australia, 1991.

There was a 70 per cent response to a mail questionnaire to a 1:3 sample of Australian Dental Association members in private practices (n = 1931). Computers were used by 37 per cent of practices. Main computer applications used were for: accounting (84%); patient billing (80%); word processing (79%); and patient recall (61%). External bureau services were used by 4 per cent of practices with most computers being in-house (single terminal 66%; multiple terminal 33%). The more dentists in a practice, the more likely was a computer to be used. Principal users were secretary/receptionists. Service and software were the most important factors in choice of computer system. Many practice computer users (67%) also had a Personal Computer at home compared with only 36 per cent of the non-users. Many respondents indicated the need for continuing education in computers (67% users; 61% non-users). More than half of the non-users indicated future use of computers for accounting, billing and recall. There has been a considerable increase in the use of computers in private practice (37%) since the Australian Dental Association Dental Practice Survey in 1983/84 (9%).

Age Factors↗

PubMed2004

A comparison of methods for the assessment of postural load and duration of computer use.

AIM: To compare two different methods for assessment of postural load and duration of computer use in office workers. METHODS: The study population existed of 87 computer workers. Questionnaire data about exposure were compared with exposures measured by a standardised or objective method. Measuring true exposure to postural load consisted of an observation of the workstation design and posture by a trained observer. A software program was used to record individual computer use. RESULTS: Comparing the answers for each item of postural load, six of eleven items showed low agreement (kappa <0.20). For six items the sensitivity was below 50%, while for eight items the specificity was 80% or higher. Computer workers were unable to identify risk factors in their workplace and work posture. On average, computer workers overestimated their total computer use by 1.6 hours. The agreement among employees who reported a maximum of three hours of computer use per day was higher than the agreement among employees with a high duration of computer use. CONCLUSIONS: Self-report by means of this questionnaire is not a very reliable method to measure postural load and duration of computer use. This study emphasises that the challenge to develop quick and inexpensive techniques for assessing exposure to postural load and duration of computer use is still open.

Adult↗

PubMed2000

Computer education. Don't forget the older GPs.

OBJECTIVE: To implement and evaluate a computer education and support program for GPs. METHODS: A 'hands-on' curriculum, based on small group learning in a clinical computing laboratory and supported via the Internet, was developed and implemented. Evaluation was threefold: observations during lessons; interviews; and participants completing a questionnaire before and six months after the course. A randomly selected group of GPs from the same region completed a modified version of the 'before' questionnaire at the same time as participating GPs were completing their six month questionnaire. Participants included 128 GPs in a computer education program in Victoria (Australia) plus 127 'control' GPs. Outcome measures were self reported computing skill, attitudes to and actual use of clinical applications. RESULTS: Six months after training, there was a significant increase in self reported computer skill (p < 0.01). Multivariate regression found that, after controlling for gender, practice characteristics, and previous training, the older (> 55 years) GPs reported greater change in their skills than their younger colleagues. The increased skill happened regardless of which or how many modules were completed, and included use of email, the Internet, computers for research and electronic prescribing. Awareness of relevant computer applications, confidence with computers and intention to use applications also increased. Participants found the dedicated clinical computing laboratory useful; however, there are significant issues with maintenance and keeping systems up-to-date. CONCLUSIONS: The computer education and support program was relevant to GP needs, deliverable and effective in improving skills and utilisation. Divisions and other GP organisations should be assisted to establish similar education and support programs and, perhaps, target older doctors.

Adult↗

PubMed2003

Increases in resident and faculty computing skills between 1998 and 2001.

BACKGROUND AND OBJECTIVES: Following a 1998 survey, we hypothesized that family practice residents would soon demand more advanced informatics and computer training than faculty could provide. We repeated the survey in 2001 to test our hypothesis. METHODS: We surveyed 97 first-year medical students, 46 family practice residents, and 18 family medicine faculty at our institution. We compared responses among groups and within groups since 1998. RESULTS: Significantly more respondents owned a computer in 2001 than in 1998. E-mail and Internet use increased dramatically for all groups. Students and faculty had significantly greater confidence in their general computer abilities than residents did in 2001, but third-year residents' confidence had increased significantly since 1998. Respondents cited inadequate computer resources as the most important barrier to effective computer use. CONCLUSIONS: Resident and faculty self-assessed computer skills have increased substantially at our program since 1998. These increases appear due to the current ubiquity of computers in society and improvements in device functionality and ease of use rather than curricular activities. Few residents and faculty need the basic computer training recommended in curricular guidelines. Residency programs should maintain up-to-date computer resources and consider providing selective advanced computer skills training.

Attitude to Computers↗

PubMed1992

Grand challenges in biomedical computing.

Advances in computing technology (both algorithms and hardware) over the next several years promise to make increasingly sophisticated computer modeling of biomedical phenomena a routine part of biomedical research. Improvements in both the absolute speed of processors and in their programming and graphics interfaces will allow nonexpert users to bring computing power equivalent to the supercomputers of a few years ago to bear on routine research problems and to display complex data in understandable ways (visualization). Although biomedical applications have traditionally not driven the leading edge of computing and supercomputing, such applications are increasingly being ported to advanced parallel and vector processors. This paper summarizes the current state of biomedical computing, citing examples of the best practice in research today. A number of projects enabled by advanced computing from various subdisciplines are described. Trends in technology for both inexpensive (workstation) and high-end computing (vector supercomputers and parallel processors) are cited; the implications of these for biomedical computing are discussed. "Grand challenges" in biomedical computing, i.e., computational problems of major scientific importance that are beyond our current capabilities but that might be achieved in a 5-year time frame, are outlined.

Attitude to Computers↗

PubMed1985

Computer literacy in nursing education. An overview.

Nursing educators are beginning to realize that computer literacy has become a survival skill for the profession. They understand that literacy must be at a level that assures the ability to manage and control the flood of available information and provides an openness and awareness of future technologic possibilities. The computer has been on college campuses for a number of years, used primarily for record storage and retrieval. However, early on a few nurse educators saw the potential for its use as a practice tool. Out of this foresight came both formal and nonformal educational offerings. The evolution of formal coursework in computer literacy has moved from learning about the computer to learning with the computer. Today the use of the computer is expanding geometrically as microcomputers become common. Graduate students and faculty use them for literature searches and data analysis. Undergraduates are routinely using computer-assisted instruction. Coursework in computer technology is fast becoming a given for nursing students and computer competency a requisite for faculty. However, inculcating computer competency in faculty and student repertoires is not an easy task. There are problems related to motivation, resources, and control. Territorial disputes between schools and colleges must be arbitrated. The interface with practice must be addressed. The paucity of adequate software is a real concern. But the potential is enormous, probably restricted only by human creativity. The possibilities for teaching and learning are profound, especially if geographical constraints can be effaced and scarce resources can be shared at minimal cost. Extremely sophisticated research designs and evaluation methodologies can be used routinely.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer-Assisted Instruction↗

PubMed2005

GNARE: automated system for high-throughput genome analysis with grid computational backend.

Recent progress in genomics and experimental biology has brought exponential growth of the biological information available for computational analysis in public genomics databases. However, applying the potentially enormous scientific value of this information to the understanding of biological systems requires computing and data storage technology of an unprecedented scale. The Grid, with its aggregated and distributed computational and storage infrastructure, offers an ideal platform for high-throughput bioinformatics analysis. To leverage this we have developed the Genome Analysis Research Environment (GNARE)--a scalable computational system for the high-throughput analysis of genomes, which provides an integrated database and computational backend for data-driven bioinformatics applications. GNARE efficiently automates the major steps of genome analysis including acquisition of data from multiple genomic databases; data analysis by a diverse set of bioinformatics tools; and storage of results and annotations. High-throughput computations in GNARE are performed using distributed heterogeneous Grid computing resources such as Grid2003, TeraGrid, and the DOE Science Grid. Multi-step genome analysis workflows involving massive data processing, the use of application-specific tools and algorithms and updating of an integrated database to provide interactive web access to results are all expressed and controlled by a "virtual data" model which transparently maps computational workflows to distributed Grid resources. This paper describes how Grid technologies such as Globus, Condor, and the Gryphyn Virtual Data System were applied in the development of GNARE. It focuses on our approach to Grid resource allocation and to the use of GNARE as a computational framework for the development of bioinformatics applications.

Computational Biology↗

PubMed1990

The technical aspects of computers.

This chapter is concerned with the technical aspects of computers. It is therefore concerned with how computers came about in the way they did, and who were the people who pioneered their development--what they were like in the early years, what they are like now, and what are likely to be the future developments. The emphasis is always on giving information to the readers so that they may know what questions to ask of the experts and, equally important, which experts to spend time with. In consequence of this last statement it becomes necessary to present a panorama showing the range of computers both size-wise and cost-wise; such scenario will therefore cover the vista from large main-frames (which must inevitably be needed in District Health Authorities and District General Hospitals) to the desk-top personal computers which all clinicians of the future will find essential. Because readers will be experiencing the impact and, hopefully, the benefits of the computer at the lower end of the size and price scale, considerable space has been devoted to explaining the various items (disc drives, monitors, printers) that pervade the microcomputer scene. New terminology must be introduced to readers if they are to discuss intelligently their computer needs to the providers of such facilities. Just as an automobile is no use without oil, petrol, water and a competent user, so the computer hardware needs computer software and a competent user. The chapter therefore continued with some considerable space being devoted to software (operating systems, programming languages, utilities and expert systems) so that the user will have clear guidance as to which path to follow in order to become a competent user of the present and future technology. Because of the rapid advances in data storage, in networking and in computer programs, the clinicians of tomorrow will have vast sources of information at their disposal. This latter will include not only patient records, but also drug data-sheets, textbooks, journals and research reports. Finally, lack of space has prevented some topics receiving more than a cursory mention. This is known but, like real life, one has to make judgements as to the relative importance of the topics and include those which come out top. It is hoped that the readers will not be too disappointed: if they absorb all that is here they will be very knowledgeable indeed.

Computer Peripherals↗

PubMed2000

Computer-aided assessment of bony nasal pyramid dimensions.

OBJECTIVE: To develop a computer-enabled paradigm for assessment of bony nasal pyramid dimensions. DESIGN: Retrospective review of archived computed tomographic data. SETTING: Tertiary level academic center. PATIENTS: Patients who had undergone computed tomographic scans for computer-aided transsphenoidal hypophysectomy were included. Previous nasal surgery, inflammatory sinus disease, and documented maxillofacial trauma were exclusion criteria. INTERVENTION: Archived computed tomographic scan images were reviewed using the software tools on a computer-aided surgical (CAS) system (StealthStation; Sofamor Danek, Memphis, Tenn). Standardized methods for the measurement of nasal bone thickness and bony nasal pyramid projection were established. MAIN OUTCOME MEASUREMENTS: Bony nasal pyramid projection and nasal bone thickness were determined. RESULTS: Computed tomographic scans from 8 patients were reviewed. Nasal bone thickness at the level of lateral osteotomy was 2.39 +/- 0.68 (mean + SD) mm, while nasal bone thickness at the level of intermediate osteotomy was 1.18 + 0.30 mm. Nasal projection from the nasomaxillary suture to the rhinion in the axial plane was 19.20 + 3. 10 (mean + SD) mm, while the corresponding nasal projection at the nasion was 20.61 + 3.52 mm. CONCLUSIONS: This brief report presents a new paradigm for the assessment of the bony nasal pyramid. Additional normative data are necessary. This information has important implications for rhinoplasty instrument design, surgical planning, and aesthetic assessment. It is likely that computer-enabled review of archived computed tomographic images for maxillofacial assessment will become increasingly accepted. Of course, further modifications of computer technology and its specific applications are expected.

Adult↗

PubMed2004

Effect of a computer-based decision aid on knowledge, perceptions, and intentions about genetic testing for breast cancer susceptibility: a randomized controlled trial.

CONTEXT: As the availability of and demand for genetic testing for hereditary cancers increases in primary care and other clinical settings, alternative or adjunct educational methods to traditional genetic counseling will be needed. OBJECTIVE: To compare the effectiveness of a computer-based decision aid with standard genetic counseling for educating women about BRCA1 and BRCA2 genetic testing. DESIGN: Randomized controlled trial conducted from May 2000 to September 2002. SETTING AND PARTICIPANTS: Outpatient clinics offering cancer genetic counseling at 6 US medical centers enrolled 211 women with personal or family histories of breast cancer. INTERVENTIONS: Standard one-on-one genetic counseling (n = 105) or education by a computer program followed by genetic counseling (n = 106). MAIN OUTCOME MEASURES: Participants' knowledge, risk perception, intention to undergo genetic testing, decisional conflict, satisfaction with decision, anxiety, and satisfaction with the intervention. Counselor group measures were administered at baseline and after counseling. Computer group measures were administered at baseline, after computer use, and after counseling. Testing decisions were assessed at 1 and 6 months. Outcomes were analyzed by high vs low risk of carrying a BRCA1 or BRCA2 mutation. RESULTS: Both groups had comparable demographics, prior computer experience, medical literacy, and baseline knowledge of breast cancer and genetic testing, and both counseling and computer use were rated highly. Knowledge scores increased in both groups (P<.001) regardless of risk status, and change in knowledge was greater in the computer group compared with the counselor group (P =.03) among women at low risk of carrying a mutation. Perception of absolute risk of breast cancer decreased significantly after either intervention among all participants. Intention to undergo testing decreased significantly after either intervention among low-risk but not high-risk women. The counselor group had lower mean scores on a decisional conflict scale (P =.04) and, in low-risk women, higher mean scores on a satisfaction-with-decision scale (P =.001). Mean state anxiety scores were reduced by counseling but were within normal ranges for both groups at baseline and after either intervention, regardless of risk status. CONCLUSIONS: An interactive computer program was more effective than standard genetic counseling for increasing knowledge of breast cancer and genetic testing among women at low risk of carrying a BRCA1 or BRCA2 mutation. However, genetic counseling was more effective than the computer at reducing women's anxiety and facilitating more accurate risk perceptions. These results suggest that this computer program has the potential to stand alone as an educational intervention for low-risk women but should be used as a supplement to genetic counseling for those at high risk.

Adult↗

PubMed1998

Computer-administered rating scales for social anxiety in a clinical drug trial.

Computer-administered versions of two clinician-administered symptom rating scales for social anxiety (the Liebowitz Social Anxiety Scale [LSAS] and the Brief Social Phobia Scale [BSPS]) and one paper-and-pencil scale (the Fear Questionnaire) were developed and utilized in a clinical trial for social phobia. The reliability and validity of the computer versions were examined, as were their equivalence to the traditional versions. Correlations between the computer and original versions were high at baseline, and remained high throughout the study. The internal consistency reliability of the computer scales was also high, and almost identical to the original versions. Mean score differences between computer and original versions were not significant at baseline, and no significant differences were found between computer and traditional versions on the amount of change detected from baseline to endpoint. Seventy-seven percent of subjects felt that the computer did not interfere with their visit at baseline and a plurality (36%) preferred the computer, with 30% preferring the clinician and 34% having no preference. By the end of the study, the plurality (41%) had no preference, with 27% preferring the computer and 32% preferring the clinician. Results support the use of these computer-administered symptom rating scales of social anxiety as a viable alternative to the clinician-administered versions with this subset of patients, which should offer researchers and clinicians a reliable and cost-effective method for evaluating social phobia.

Adolescent↗

PubMed2006

Performance of an automated computer-based scoring method to assess joint space narrowing in rheumatoid arthritis: a longitudinal study.

OBJECTIVE: To compare the diagnostic performance of a computer-based method for measuring joint space width with the Sharp joint space narrowing (JSN) scoring method in patients with rheumatoid arthritis (RA). METHODS: A random sample of patients with early RA, for whom sequential hand radiographs and Sharp scores were available, was selected from the National Data Bank for Rheumatic Diseases. Hand joint space width was measured using an automated, computer-based method in random order and with blinding for clinical information. We constructed a receiver operating characteristic curve and compared the diagnostic performance of the computer-based and Sharp methods based on the areas under the curve. RESULTS: One hundred twenty-nine patients with early RA who underwent serial radiography were included. Changes in the computer-based and Sharp methods were highly correlated (r = 0.75, P < 0.001). The computer-based method was significantly more discriminant than the Sharp JSN subscale. The area under the curve of the computer-based method was 0.96 (95% confidence interval [95% CI] 0.94, 0.99) compared with 0.93 (95% CI 0.89, 0.96) for the Sharp subscale (P = 0.024). At the most discriminant cutoff, specificity of the computer-based method was 88.4% compared with 81.4% for the Sharp subscale (P = 0.11); sensitivity was 87.6% for the computer-based method compared with 82.2% for Sharp subscale (P = 0.19). The signal-to-noise ratio for the computer-based method was 83% compared with 70% for the Sharp subscale (P = 0.013). CONCLUSION: The computer-based method for measuring joint space width is more discriminant than the semiquantitative Sharp JSN subscale.

Adult↗

PubMed2000

Computer use and physical inactivity in young adults: public health perils and potentials of new information technologies.

Physical inactivity contributes to premature mortality and morbidity and increasing prevalences of overweight and obesity in industrialized countries. Computer use is an increasingly common sedentary behaviour, potentially displacing physical activity. Physical activity and computer use were examined in 697 young adults (18-30 years). Energy expenditure estimates were derived from self-reported walking, moderate, and vigorous activity; participants were classified as sedentary, low, moderate, or high in their level of activity. For multivariate analyses, two categories of physical activity were used: inactive (sedentary/low activity; < 800 kcal.week-1) or active (moderate/high activity; > or = 800 kcal.week-1). Time spent in computer-related activities was summed, and computer use tertiles calculated (< 3 hours.week-1; 3-8 hours.week-1; > 8 hours.week-1). Those in the highest tertile of computer use were most likely to be inactive (p = 0.003) and most likely to report computer use as a barrier to physical activity (p < 0.001). The majority of those in the top two tertiles of computer use, and of the inactive, preferred obtaining information from computers than from conventional print media. These findings suggest that computer use plays a significant role in the discretionary time of young adults and is negatively associated with physical activity. Computer-mediated communication has potential in disseminating interventions to increase physical activity in young adults.

Adolescent↗

PubMed1993

Use of the computer for interpretation of fetal heart tracings.

OBJECTIVE: To compare the interpretations of antepartum fetal heart tracing by computer and by three experts. METHOD: One hundred and forty-eight patients with high risk pregnancies were included. Their fetal heart tracing was interpreted by each of the three experts and the computer. The interpretation of whether it was reactive or nonreactive, by each of the experts with that of the computer controlling for the outcome, were cross-tabulated using the chi 2-test with a control variable. To define the abnormal outcome the odds ratio and 95% confidence interval were used. RESULTS: The computer defined 14 tracings as nonreactive and the experts, respectively, 19, 18 and 17. The gestation age ranged from 34 to 42 weeks with a mean of 38.26 and standard deviation of 2.31. The common reasons for monitoring were diabetes (20.9%), hypertension (20.3%) and post-date (11.9%). Out of 148, 16 had an abnormal fetal outcome. There were no statistically significant differences between any of the experts and the computer in determining the normal outcome. However, to determine the abnormal outcome, there was a statistically significant difference between two of the experts and the computer with P < 0.025. It was found that the computer was superior to any of the experts in defining the abnormal outcome with an odds ratio of 55.9 and experts odds ratio and 95% computer interpretation were 1.6 (0.4-6.5), 1.0 (0.2-4.9) and 1.1 (0.2-5.3), respectively. CONCLUSION: There was no difference between the experts and the computer in defining the normal outcome, but it appears that the computer was better in defining the abnormal outcome.

Female↗

PubMed1982

Patient stress and the computer in the consulting room.

This study assesses patient reactions to the use of diagnostic computers by doctors. The setting was a hospital out-patient clinic, and the patients were new referrals with dyspeptic symptoms. Patient reactions were measured through a mood questionnaire of stress and arousal, and a questionnaire on attitudes to the medical use of computers. Patient self-reported stress was more likely to have increased after the consultation if the computer had been used (P less than 0.05). There was a trend for computer patients to show attenuation of the typical post-consultation drop in stress. However, patients who had experienced the computer being used had more favourable attitudes towards medical computer use that inexperienced patients (as assessed by a subsequent postal survey; P = 0.007). Multiple regression showed that while experience of the computer was a determinant of attitudes, patient stress after the consultation was extremely significant (P less than 0.001) with highly-stressed patients being the least welcoming to medical computers, whether or not they had experience of the computer. It is suggested that doctors planning to use computers should take care to preserve their 'human touch' particularly for nervous patients.

Adult↗

PubMed1985

Patient rating of doctors using computers.

In order to shed some light on the impact of a computer on medical consultations, 140 new hospital out-patients rated the doctor they had just seen, and their ideal doctor using a 38-item semantic differential-type scale. Sixty-four of the patients had experienced a computer being used by one of the three doctors participating in the study. Each patient's ratings of a doctor were compared with their ratings of the ideal doctor by paired t-tests. The doctors, when using the computer, tended to be seen as less matching up to these ideals than when they did not use the computer. All three received more non-ideal ratings when using the computer. However, this was less so for two of the doctors than for the third, who with a computer was seen as less than ideally listening and paying attention, and was also rated as less than ideally warm, friendly, liking and comforting, perhaps surprisingly, this doctor had tried to minimize the effect of the computer during the consultation, while the doctor who used the computer 'conversationally' during the interview was rated overall as better with it than without it. It would appear that the pattern of computer use in the consultation and even its apparent intrusiveness need not have an adverse effect on patient ratings of doctors, but that computer use can cause problems for this aspect of the doctor-patient relationship.

Adult↗

PubMed2004

Computer-assisted assessment of depression and function in older primary care patients.

We wanted to test the psychometric reliability and validity of self-reported information on psychological and functional status gathered by computer in a sample of primary care outpatients. Persons aged 65 years and older visiting a primary care medical practice in Baltimore (n=240) were approached. Complete baseline data were obtained for 54 patients and 34 patients completed 1-week retest follow-up. Standard instruments were administered by computer and also given as paper and pencil tests. Test-retest reliability estimates were calculated and comparisons across mode of administration were made. Separately, an interviewer administered a questionnaire to gauge patient attitudes and feelings after using the computer. Most participants (72%) reported no previous computer use. Nevertheless, inter-method reliability of the GDS15 at baseline (0.719, n=47), intra-method reliability of the computer in time (0.797, n=31), inter-method reliability of the CESDR20 at baseline (0.740, n=53), and the correlation between the CESDR20 computer version at baseline and follow-up (0.849, n=34) were all excellent. The inter-method reliability of the CESDR20 at follow-up (0.615, n=37) was lower but still acceptable. Although 28% were anxious prior to using the computer testing system, that percent decreased to 19% while using the system. The efficiency and reliability in comparison to the paper instruments were good or better. Even though most participants had not ever used a computer prior to participating in the study, they had generally favorable attitudes toward the use of computers, and also reported having favorable experience with the computer testing system.

Age Distribution↗

PubMed2000

Computing with DNA by operating on plasmids.

A new method of computing using DNA plasmids is introduced and the potential advantages are listed. The new method is illustrated by reporting a laboratory computation of an instance of the NP-complete algorithmic problem of computing the cardinal number of a maximal independent subset of the vertex set of a graph. A circular DNA plasmid, specifically designed for this method of molecular computing, was constructed. This computational plasmid contains a specially inserted series of DNA sequence segments, each of which is bordered by a characteristic pair of restriction enzyme sites. For the computation reported here, the DNA sequence segments of this series were used to represent the vertices of the graph being investigated. By applying a scheme of enzymatic treatments to the computational plasmids, modified plasmids were generated from which the solution of the computational problem was selected. This new method of computing is applicable to a wide variety of algorithmic problems. Further computations in this style are in progress.

Computing Methodologies↗