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PubMed2006

Flexible real-time control of MagStim 200(2) units for use in transcranial magnetic stimulation studies.

A method for two-way serial communication with MagStim 200(2) BiStim units using LabVIEW is described. A suite of LabVIEW 'virtual instruments' which give simple and reliable control of pulse parameters and delivery is described and made freely available online. The advantages of serial control include the ability to quickly and reliably change pulse parameters during an experiment, to randomly intersperse pulses with different parameters without manually resetting the unit, to deliver pulses with a reliable temporal relationship to other external events, and to control pulse parameters interactively. An application that uses the method for adaptive control of pulse intensity is reported.

Adult↗
PubMed1986

Computerization in industry causes problems for people with reading and writing difficulties (dyslexia).

For 10 years computerization in industry has advanced at a rapid pace. A problem which has not received attention is that of people with reading and writing difficulties who experience severe problems when they have to communicate with a computer monitor screen. These individuals are often embarrassed by their difficulties and conceal them from their fellow workers. A number of case studies are described which show the form the problems can take. In one case, an employee was compelled to move from department to department as each was computerized in turn. Computers transform a large number of manual tasks in industry into jobs which call for reading and writing skills. Better education at elementary school and at the workplace in connection with computerization are the most important means of overcoming this problem. Moreover, computer programs could be written in a more human way.

Adult↗
PubMedDate not supplied

Using laptop computers as a BMET field service tool.

This system has been in operation for approximately two years at the time of this writing, and involves more than a dozen laptop computers. The true test of whether something is successful is the degree of acceptance that is generated by the people who must use it. Approximately two months after beginning this process, our biomedical equipment technicians (BMETs) asked us to expand utilization of this system to a greater segment of our client base because it was so much simpler than our prior paper method. Our ability to track events that occur in the field is much improved with any problems identified in procedures being communicated through the private comments. Not only are the printed PM forms far more legible than the prior hand-entered results, but the concept of test-to-standards now is far more practical because the testing protocols are a keypress away, and the question of whether the technician would take the time to look up in the cumbersome procedure manuals those things that he or she was only slightly unsure of is addressed. Additionally, we have seen more than a 25% reduction in data-handling associated with the processing of the PM inspections in this fashion. Even with the time necessary to create the data disks, upload them, and process them through the filter, we are still saving substantial time over the manual handling of paper.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomedical Engineering↗
PubMedDate not supplied

The DSM-III-R versus nursing diagnosis: a dilemma in interdisciplinary practice.

Given the dynamics of the multidisciplinary team and the infancy of nursing diagnoses specific to psychiatric nursing, most nurses prefer using the DSM-III-R to document practice or do not see nursing diagnoses as relevant. The DSM-III-R, first published as the Diagnostic and Statistical Manual in 1952, is specific to the medical care of individuals and oriented toward "cure"; nursing diagnoses, initiated in 1973, are applicable to individuals, families, and groups and address human response to actual or potential health problems. The similarities of these two diagnostic systems include being a guide to practice, evolving as works of political compromise with international import, and serving as communication systems. However, without understanding the differences or similarities between these linguistic systems, nurses opting to use only the DSM-III-R do not contribute to understanding phenomena germane to psychiatric nursing, perpetuate the invisibility of nursing to patient care, and invite turf battles with other professions.

Humans↗
PubMed1987

[Comparison of wound healing of intestinal anastomosis by stapling devices and by Gambee's suture under normal and abnormal conditions in dog].

We investigated the wound healing of canine colon anastomosis by stapling devices (EEA and Nakayama's curved shaft device) comparing with that by Gambee's suture with special reference to vascularity of staple line, local blood flow, endoscopical findings, pathological findings and fluorescein viability test under normal and abnormal conditions. Development of vascular network and communication at the suture lines by stapler using a silicon rubber injection observed on the following days after operation. The local blood flow at the anastomosis measured by hydrogen gas clearance method increased gradually after operation. Endoscopic examination showed mucosal agglutination at the suture line by staplers was delayed compared to that of Gambee's suture. Under normal condition, the vascular communication of suture line by Gambee's was observed on the 5th post operative day, whereas it was observed on the 7th day by Staplers. Stainless steel staples were considered to be less reactive to the tissue than the other suture materials. Under abnormal condition, wound healing was delayed because of the prolonged inflammation and edema. No remarkable difference was observed between manual anastomosis (Gambee) and stapled anastomosis under abnormal condition.

Animals↗
PubMedDate not supplied

Interfacing the PACS and the HIS: results of a 5-year implementation.

An interface was created between the Department of Defense's hospital information system (HIS) and its two picture archiving and communication system (PACS)-based radiology information systems (RISs). The HIS is called the Composite Healthcare Computer System (CHCS), and the RISs are called the Medical Diagnostic Imaging System (MDIS) and the Digital Imaging Network (DIN)-PACS. Extensive mapping between dissimilar data protocols was required to translate data from the HIS into both RISs. The CHCS uses a Health Level 7 (HL7) protocol, whereas the MDIS uses the American College of Radiology-National Electrical Manufacturers Association 2.0 protocol and the DIN-PACS uses the Digital Imaging and Communications in Medicine (DICOM) 3.0 protocol. An interface engine was required to change some data formats, as well as to address some nonstandard HL7 data being output from the CHCS. In addition, there are differences in terminology between fields and segments in all three protocols. This interface is in use at 20 military facilities throughout the world. The interface reduces the amount of manual entry into more than one automated system to the smallest level possible. Data mapping during installation saved time, improved productivity, and increased user acceptance during PACS implementation. It also resulted in more standardized database entries in both the HIS (CHCS) and the RIS (PACS).

Computer Systems↗
PubMed2005

Validating DICOM content in a remote storage model.

Verifying the integrity of DICOM files transmitted between separate archives (eg, storage service providers, network attached storage, or storage area networks) is of critical importance. The software application described in this article retrieves a specified number of DICOM studies from two different DICOM storage applications; the primary picture archiving and communication system (PACS) and an off-site long-term archive. The system includes a query/retrieve (Q/R) module, storage service class provider (SCP), a DICOM comparison module, and a graphical user interface. The system checks the two studies for DICOM 3.0 compliance and then verifies that the DICOM data elements and pixel data are identical. Discrepancies in the two data sets are recorded with the data elements (tag number, value representation, value length, and value field) and pixel data (pixel value and pixel location) in question. The system can be operated automatically, in batch mode, and manually to meet a wide variety of use cases. We ran this program on a 15% statistical sample of 50,000 studies (7500 studies examined). We found 2 pixel data mismatches (resolved on retransmission) and 831 header element mismatches. We subsequently ran the program against a smaller batch of 1000 studies, identifying no pixel data mismatches and 958 header element mismatches. Although we did not find significant issues in our limited study, given other incidents that we have experienced when moving images between systems, we conclude that it is vital to maintain an ongoing, automatic, systematic validation of DICOM transfers so as to be proactive in preventing possibly catastrophic data loss.

Computer Communication Networks↗
PubMed2004

Syndromic surveillance using regional emergency medicine internet.

STUDY OBJECTIVE: We demonstrate the feasibility and utility of emergency department (ED) syndromic surveillance using a regional emergency medicine Internet application to minimize impact on ED and public health staffing. METHODS: Regional (multi-ED) surveillance was established for 2 periods, one characterized by a high-profile national sports event and the other during an international disease outbreak. Counts of patient visits meeting syndrome criteria and total patient visits were reported daily on the secure regional emergency medicine Internet site and downloaded by public health staff. Trends were analyzed and displayed on the secure Web site. ED participants were surveyed about the acceptability and time cost of the project. RESULTS: In the first ("All Star Game") project, 8 departments reported daily counts for 4 weeks, covering more than 26,000 patient visits. In the second ("severe acute respiratory syndrome" [SARS]) project, an average of 11 departments in the same region reported daily data on febrile respiratory illnesses, travel, and contacts for 10 weeks. Experience with the first project allowed for rapid implementation of the second project during a 3-day period. In both instances, the surveillance efforts were undertaken without the need for extraordinary ED or public health staffing requirements. CONCLUSION: A regional emergency medicine Internet approach permitted rapid implementation of multisite syndromic surveillance without additional staff. Some problems were identified with the first project, related to clinician checklist completion and manual data tabulation and entry. The SARS project addressed these by simplifying data collection and restricting it to triage.

Bioterrorism↗
PubMed2006

The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: a research review.

PURPOSE: This article presents the results of a meta-analysis to determine the effect of augmentative and alternative communication (AAC) on the speech production of individuals with developmental disabilities. METHOD: A comprehensive search of the literature published between 1975 and 2003, which included data on speech production before, during, and after AAC intervention, was conducted using a combination of electronic and hand searches. RESULTS: The review identified 23 studies, involving 67 individuals. Seventeen of these studies did not establish experimental control, thereby limiting the certainty of evidence about speech outcomes. The remaining 6 studies, involving 27 cases, had sufficient methodological rigor for the "best evidence analysis" (cf. >R. E. Slavin, 1986). Most of the participants (aged 2-60 years) had mental retardation or autism; the AAC interventions involved instruction in manual signs or nonelectronic aided systems. None of the 27 cases demonstrated decreases in speech production as a result of AAC intervention, 11% showed no change, and the majority (89%) demonstrated gains in speech. For the most part, the gains observed were modest, but these data may underestimate the effect of AAC intervention on speech production because there were ceiling effects. CONCLUSIONS: Future research is needed to better delineate the relationship between AAC intervention and speech production across a wider range of participants and AAC interventions.

Adolescent↗
PubMed2006

[Satisfaction with technological equipment in individuals with tetraplegia following spinal cord injury].

OBJECTIVE: To measure the acquisition, use and satisfaction with high technology equipment by spinal cord injured tetraplegic subjects. DESIGN AND SETTING: A questionnaire was mailed to 102 tetraplegic subjects who were hospitalised in the rehabilitation center of Kerpape (Ploemeur, France) between 1998 and 2004, and 59 subjects responded. The questionnaire asked about the use of telephones, computers, wheelchairs and environmental controls at home. RESULTS: When a piece of equipment was acquired, it was very often used. Patient satisfaction with equipment was 79.3%. Home phones and mobile phones were often used with options such as hands-free devices (78 and 59% respectively). A total of 64.4% of subjects acquired a manual wheelchair and 61% a power wheelchair. The most commonly acquired options on the power wheelchairs were the powered recline (73,7%) and tilt (71,1%) systems. All options were used but all were more desired than acquired. A total of 27.1% of subjects desired a pushrim-activated power-assist wheelchair, but only 15.3% had acquired one; 695% of subjects had a computer. Communication was the first use for the computer (82.5%); 49.2% of subjects had acquired an environmental control system, but 20% desired one. The first reason for lack of acquisition was financial difficulties but also accessibility and information problems. The factor that influenced the acquisition and need for equipment was the degree of spinal cord injury. No other factor reduced patient satisfaction with equipment. CONCLUSION: Patients were satisfied with the equipment they acquired. But their needs, especially wheelchair options and environmental control systems, were not satisfied.

Adult↗
PubMed2002

Rudimentary uterine horn pregnancy. The 20th-century worldwide experience of 588 cases.

OBJECTIVE: To investigate the outcomes of rudimentary uterine horn pregnancies and to identify trends and opportunities for improvement in patient care. STUDY DESIGN: During the period 1900-1999, 588 cases of rudimentary uterine horn pregnancy were identified using both manual and computerized searches of Index Medicus, Excerpta Medica and the Index-Catalogue of the Library of the Surgeon-General's Office of the United States Army as well as standard reference tracing. Nine characteristics of each case were evaluated: (1) fetal status at birth, (2) maternal survival, (3) neonatal survival, (4) gestational age at delivery, (5) whether the rudimentary horn ruptured, (6) communication status of the horn with the contralateral hemiuterus, (7) gravidity and parity, (8) side of the horn, and (9) order of the gestation. RESULTS: Newborn survival ranged from 0-13% by decade and trended upward. Eighty-five percent of pregnancies occupied noncommunicating horns. Thirty percent of gestations progressed to term or beyond. Fifty percent of pregnant uterine horns ruptured, with 80% of these events occurring before the third trimester. There was no trend in either the incidence or timing of uterine horn rupture during the century. Maternal mortality decreased from 6% to 23% during the first half of the century to < 0.5% currently. Twin pregnancies consisted of 5.3% of cases. CONCLUSION: Neonatal survival has improved greatly for rudimentary horn pregnancies, and maternal mortality has decreased significantly. Such pregnancies are now identifiable early in gestation by obstetric imaging studies, and there can be guarded optimism that favorable trends in outcomes will continue into the 21st century.

Adult↗
PubMedDate not supplied

Diagnostic accuracy of a teleradiology image transmission system.

Teleradiology is the remote interpretation of digitized radiographic images by physicians. The images are usually transmitted over telephone lines, but satellite communication has also been used. The interpretability of the transmitted image is an important factor in the operation and use of teleradiology systems. Commercially available equipment has certain built-in functions that may enhance the interpretability of the image received. These functions and their usefulness in diagnosis are described. It is also possible to enhance the image for transmission, prior to digitizing, by certain manual techniques. These may be of value in situations where the first transmission is lacking in some quality. A test of these functions and techniques is reported.

Diagnostic Imaging↗
PubMed2002

Does training increase the use of more emotionally laden words by nurses when talking with cancer patients? A randomised study.

The emotional content of health care professionals-cancer patient communication is often considered as poor and has to be improved by an enhancement of health care professionals empathy. One hundred and fifteen oncology nurses participating in a communication skills training workshop were assessed at three different periods. Nurses randomly allocated to a control group arm (waiting list) were assessed a first time and then 3 and 6 months later. Nurses allocated to the training group were assessed before training workshop, just after and 3 months later. Each nurse completed a 20-min clinical and simulated interview. Each interview was analysed by three content analysis systems: two computer-supported content analysis of emotional words, the Harvard Third Psychosocial Dictionary and the Martindale Regressive Imagery Dictionary and an observer rating system of utterances emotional depth level, the Cancer Research Campaign Workshop Evaluation Manual. The results show that in clinical interviews there is an increased use of emotional words by health care professionals right after having been trained (P=0.056): training group subjects use 4.3 (std: 3.7) emotional words per 1000 used before training workshop, and 7.0 (std: 5.8) right after training workshop and 5.9 (std: 4.3) 3 months later compared to control group subjects which use 4.5 (std: 4.8) emotional words at the first assessment point, 4.3 (std: 4.1) at the second and 4.4 (std: 3.3) at the third. The same trend is noticeable for emotional words used by health care professionals in simulated interviews (P=0.000). The emotional words registry used by health care professionals however remains stable over time in clinical interviews (P=0.141) and is enlarged in simulated interviews (P=0.041). This increased use of emotional words by trained health care professionals facilitates cancer patient emotion words expressions compared to untrained health care professionals especially 3 months after training (P=0.005). This study shows that health care professionals empathy may be improved by communication skills training workshop and that this improvement facilitates cancer patients emotions expression.

Adult↗
PubMedDate not supplied

Testing health care professionals' communication skills: the usefulness of highly emotional standardized role-playing sessions with simulators.

Although standardized role-playing sessions (SRPS) with simulators are increasingly used to assess health care professionals' (HCPs) communication skills (CS) and the effectiveness of training workshops (TWs), nothing has been done to date to define the optimal emotional content of SRPS. Three emotionally different SRPS contexts-weakly emotional (WE-), moderately emotional (ME-), and highly emotional (HE-SRPS)-were, therefore, tested in order to assess induced CS and sensitivity to TW-related changes. The study included 25 HCPs. Tape-recorded SRPS, scheduled before and after the TW, were retranscribed, and assessed according to the Cancer Research Campaign Workshop Evaluation Manual (CRCWEM), which provides a rating of form, function and structure for each utterance. Results show that induced CS are different in WE-, ME-, and HE-SRPS, regarding form (HE-SRPS induced more 'directing', 'leading' or 'multiple' questions; WE: 20.7%; ME: 19.7%; HE: 33.7% (p<0.001)); function (HE-SRPS induced more 'inappropriate' information; WE: 6. 5%; ME: 8.2%; HE: 15.6% (p<0.001)); and blocking (HE-SRPS induced more 'blocking' utterances; WE: 7.2%; ME: 13.8%; HE: 30.2% (p<0. 0001)). Finally, CS changes induced by TWs are the highest in HE-SRPS (14.8% increase of 'open' questions for the HE- versus 1.0% for the WE-SRPS; 11.6% decrease of 'inappropriate' information for the HE- versus 3.3% for the WE-SRPS; and 17.5% decrease of 'blocking' for the HE- versus 2.6% for the WE-SRPS). In conclusion, SRPS, with a HE content, induce more inappropriate CS. Moreover, they are more sensitive to TW effects. SRPS with a HE content should, thus, be recommended for the assessment of TW effectiveness.

Adult↗
PubMed2005

Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors.

In a randomized controlled design, this study tested the efficacy of a theoretically based uncertainty management intervention delivered to older long-term breast cancer survivors. The sample included 509 recurrence-free women (360 Caucasian, 149 African-American women) with a mean age of 64 years (S.D.=8.9 years) who were 5-9 years post-treated for breast cancer. Women were randomly assigned to either the intervention or usual care control condition. The intervention was delivered during four weekly telephone sessions, in which study nurses guided cancer survivors in the use of audiotaped cognitive-behavioral strategies to manage uncertainty about recurrence, and a self-help manual designed to help women understand and manage long-term treatment side effects and other symptoms. Treatment outcome data on uncertainty management were gathered at pre-intervention and 10-months afterward. Repeated measures MANOVA evaluating treatment group, ethnic group, and treatment by ethnic interaction effects indicated that training in uncertainty management resulted in improvements in cognitive reframing, cancer knowledge, patient-health care provider communication, and a variety of coping skills. Results are discussed in terms of the importance of theory-based interventions for cancer survivors that target triggers of uncertainty about recurrence and in terms of ethnic differences in response to the intervention.

Adaptation, Psychological↗
PubMed1994

Business process reengineering: a remedy for health care.

Health care organizations are facing significant economic constraints that threaten to dismantle core services. The perceived need for reform is great. Business process reengineering may be the strong medicine required to achieve dramatic productivity improvement without jeopardizing the quality and scope of core health care services. Reengineering challenges health care organizations to eliminate functions that do not contribute to a flattened organization structure in which fewer care providers deliver a wider range of health care services. Information technology is used to displace manual checks and controls. Reengineering may facilitate the implementation of contemporary management models, such as patient-focused care, case management and product or program management. The product of reengineering can be enhanced over time by Continuous Quality Improvement.

Canada↗
PubMed1997

Web-based data integration and annotation in the intensive care unit.

Integrating patient data to facilitate review and annotation is a challenging task in the intensive care unit (ICU), partially due to the wide variety of proprietary systems and types of data involved. This paper describes SIMON-Web, a Java-based user interface to integrate data from an existing bedside monitoring system and a clinical information system (CIS). SIMON-Web displays graphical data from physiologic monitors and other bedside devices as well as information from the clinical laboratory and physician order-entry systems, and allows users to annotate the data using a point-and-click or free-text interface. By continuing to add functionality to SIMON-Web's extensible user interface, we hope to continue to augment and eventually replace manual care provider data charting in the ICU. As of March, 1997, SIMON-Web has been implemented on two bedside personal computer workstations in the cardiac care unit (CCU) at Vanderbilt University Medical Center.

Computer Communication Networks↗
PubMed2005

Improving physician communication through an automated, integrated sign-out system.

Communication failures among physicians are a leading cause of medical errors. The resident sign-out sheet is the primary tool used by house staff to facilitate the sign-out process. The resident sign-out sheet is a structured report, with patient-specific information including demographics, such a patient's name, age, sex, room number, and attending physician; problem list; medications; and allergies. Some physicians use handwritten notes to keep track of this information, while others use freestanding word processor or database programs. In a previous study, the authors described serious inaccuracies in a manually updated word-processor based resident sign-out sheet used by pediatric residents at a tertiary-care children's hospital. An automated and integrated sign-out system (AISS) was subsequently developed that retrieves pertinent patient information from a computerized provider order entry (CPOE) system. The AISS generates a resident sign-out sheet, which includes demographic information, weight, current medications, allergies, and diet orders, as well as optional free-text information. The AISS has proven to be enormously popular, increasing physician acceptance of CPOE throughout the organization. This paper discusses lessons learned, including technical, design, and workflow aspects of an integrated resident sign-out sheet. The authors recommend that all future commercial CPOE systems incorporate physician sign-out tools such as the one described in this article.

Communication↗