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PubMed2006

The influence of three-dimensional computed tomography reconstructions on the characterization and treatment of distal radial fractures.

BACKGROUND: Computed tomography identifies important characteristics of distal radial fractures better than plain radiographs do. Our hypothesis was that three-dimensional computed tomography images would further increase the reliability and accuracy of radiographic characterization of distal radial fractures. METHODS: Four independent observers evaluated radiographic images of thirty intra-articular fractures of the distal part of the radius for the presence of a fracture line in the coronal plane, impacted central articular fragments, the presence of comminution (defined as more than three articular fragments), and the number of fracture fragments. A treatment was selected on the basis of the interpretation of the radiographic studies. Three rounds of evaluation were compared: (1) radiographs and two-dimensional computed tomography, (2) radiographs and three-dimensional computed tomography two weeks later, and (3) all three types of images two weeks after that. This cycle was then repeated to assess intraobserver reliability. RESULTS: Three-dimensional computed tomography improved the intraobserver agreement, but not the interobserver agreement, regarding the presence of coronal plane fracture lines and central articular fragment depression. Three-dimensional computed tomography improved both the intraobserver and the interobserver agreement regarding the presence of articular comminution. Interobserver agreement increased when three-dimensional computed tomography was used to determine the exact number of articular fracture fragments. The sensitivity and accuracy of identifying specific fracture characteristics (as compared with intraoperative findings) improved when three-dimensional imaging was used in conjunction with two-dimensional imaging as compared with two-dimensional imaging alone. The addition of three-dimensional computed tomography to two-dimensional computed tomography influenced treatment recommendations, resulting in a significantly greater number of decisions for an open approach (p < 0.05) and combined dorsal and volar exposure (p < 0.001). CONCLUSIONS: Three-dimensional computed tomography improves both the reliability and the accuracy of radiographic characterization of articular fractures of the distal part of the radius and influences treatment decisions. Future studies will be required to determine the impact of these decisions on patient outcome.

Adult↗
PubMed2003

Improvement in sensitivity of screening mammography with computer-aided detection: a multiinstitutional trial.

OBJECTIVE: Our study evaluated radiologist detection of breast cancer using a computer-aided detection system. MATERIALS AND METHODS: Three radiologists reviewed 377 screening mammograms interpreted as showing normal or benign findings 9-24 months before cancer diagnosis from 17 of the 18 participating centers. In 313 cases, study radiologists recommended additional mammographic evaluation. In 177 cases, the area warranting additional workup precisely correlated with the subsequently diagnosed cancer. These 177 missed cancers were evaluated with computer-aided detection. The proportion of radiologists identifying the missed cancers was used to determine radiologist sensitivity without computer-aided detection. RESULTS: The study radiologists determined that 123 of the 377 missed cancer cases warranted workup. Therefore, 123 additional cancers cases could have been found. The calculated radiologist sensitivity without computer-aided detection was therefore 75.4% (377 / [377 + 123]). Similarly, using the performance of the system on the missed cancers, we estimated that 80 (65.0%) of these 123 missed cancer cases would have been identified with the use of computer-aided detection. Consequently, the estimated sensitivity of radiologists using computer-aided detection was 91.4% ([377 + 80] / [377 + 123])-resulting in a 21.2% ([91.4% / 75.4%] - 1) increase in radiologist sensitivity with computer-aided detection. CONCLUSION: Use of the computer-aided detection system significantly improved the detection of breast cancer by increasing radiologist sensitivity by 21.2%. Therefore, for every 100,000 women with breast cancer identified without the use of computer-aided detection, an estimated additional 21,200 cancers would be found with the use of computer-aided detection.

Adult↗
PubMedDate not supplied

A personal computer network system for equitable allocation of cadaver organs.

We developed a personal computer network system for the equitable allocation of cadaveric organs. This network consists of a host computer (IBM PS55 model 5570 T) and various kinds of personal computers manufactured by many different computer makers in Japan. The merits of our personal computer network include lower cost and an easy access to the host computer from all the centres participating in this network while using their own favourite personal computers. Among the programs made for allocating cadaveric organs, we present in this paper the program for livers. This program was developed with a modified version of the logic developed by Starzl et al. The grade modification for the United Network for Organ Sharing (UNOS) in the United States was used as the basis for classification of medical urgency. Our program weighed the factors of medical urgency, compatibility of blood group and waiting time. Distance factors were omitted because of the smaller area of the network compared to that of UNOS. This computer network would be linked to other computer networks in creating a national organ procurement and transplant network in Japan, in order to help them to catch up with other advanced transplant countries. Such an equal and objective computer system should allow organ transplantation to become more widely accepted.

Computer Communication Networks↗
PubMedDate not supplied

The meaning of computers to a group of men who are homeless.

The purpose of this pilot study was to explore the experience with computers and the meaning of computers to a group of homeless men living in a long-term shelter. This descriptive exploratory study used semistructured interviews with seven men who had been given access to computers and had participated in individually tailored occupation based interventions through a Work Readiness Program. Three themes emerged from analyzing the interviews: access to computers, computers as a bridge to life-skill development, and changed self-perceptions as a result of connecting to technology. Because they lacked computer knowledge and feared failure, the majority of study participants had not sought out computers available through public access. The need for access to computers, the potential use of computers as a medium for intervention, and the meaning of computers to these men who represent the digital divide are described in this study.

Adult↗
PubMed2000

Using handheld computers to document family practice resident procedure experience.

BACKGROUND AND OBJECTIVES: We examined the use of inexpensive handheld computers in documenting resident procedures. With a handheld computer, data is entered at the time of the procedure, eliminating the problem of double entry. METHODS: Connectivity and ease of use were important factors considered when choosing a handheld computer. All residents received a handheld computer for data entry. Residency staff downloaded the data to a desktop computer. At the same time, data useful to residents was placed on their devices. The process of generating individual and program reports required 2 hours of staff time each month. Survey data regarding use and acceptance by residents was collected. RESULTS: Eighty-eight percent of residents collected data on their handheld computer. Those residents responding to a survey felt that the handheld computer was "very useful," and 73% reported daily use. Initial costs were $310 per resident. CONCLUSIONS: Handheld computers streamlined the collection of procedure data for family practice residents. Handheld computers assisted in producing timely and useful procedural reports for both residents and the residency program. Additional uses of handheld computers were beneficial to the program and the residents.

Computers↗
PubMed2002

21st-century health care: the effect of computer use by physicians on patient satisfaction at a family medicine clinic.

BACKGROUND AND OBJECTIVES: Trust and satisfaction in the physician-patient relationship is the cornerstone of family medicine. Today, computers are playing an increasingly prominent role in the delivery of health care, yet recent data detailing their effect on the physician-patient relationship are limited. For physicians to "first do no harm," it is critical to determine that computers used at the point of care do not decrease patient satisfaction, because this is a good proxy for the physician-patient relationship. This study assessed patients' views of computer use and its effect on patient satisfaction in a family medicine clinic before and after implementation of an electronic environment developed by our institution. METHODS: A survey was mailed to patients who had been evaluated at a family medicine clinic for hypertension, high blood pressure without hypertension, or hyperlipidemia. These diseases were selected because they are common and require strong physician-patient relationships for successful treatment. The survey assessed patients' overall satisfaction with health care received at the clinic and their opinions about how their physician's computer use affected their visit. This survey was compared with a survey done in 1995 at the same clinic, before adoption of the electronic environment. RESULTS: A total of 478 patients were enrolled in the study; 304 (63.6%) of these returned surveys. A majority of the patients (74.6%) thought that the computer had an overall positive impact on the quality of care provided. There was a positive association between a physician's computer skills, as rated by patients, and the patients' satisfaction with the computer's effect on the visit. There were no differences in overall satisfaction between the 1995 survey and the current survey. CONCLUSIONS: This study shows that physician competence with computers plays an important role in patient satisfaction and that computers can be integrated into the office visit without a detrimental effect on patient satisfaction. Surprisingly, patient familiarity with computers was shown to have a slight negative correlation with patient satisfaction. These findings are significant in view of research indicating that compliance, health outcomes, perception of physician competence, and malpractice suits are all related to physicians' interpersonal skills and patient satisfaction.

Attitude to Computers↗
PubMed2005

Computer skills for the next generation of healthcare executives.

Students beginning a career in healthcare administration must possess an array of professional and management skills in addition to a strong fundamental understanding of the field of healthcare administration. Proficient computer skills are a prime example of an essential management tool for healthcare administrators. However, it is unclear which computer skills are absolutely necessary for healthcare administrators and the extent of congruency between the computer skills possessed by new graduates and the needs of senior healthcare professionals. Our objectives in this research are to assess which computer skills are the most important to senior healthcare executives and recent healthcare administration graduates and examine the level of agreement between the two groups. Based on a survey of senior healthcare executives and graduate healthcare administration students, we identify a comprehensive and pragmatic array of computer skills and categorize them into four groups, according to their importance, for making recent health administration graduates valuable in the healthcare administration workplace. Traditional parametric hypothesis tests are used to assess congruency between responses of senior executives and of recent healthcare administration graduates. For each skill, responses of the two groups are averaged to create an overall ranking of the computer skills. Not surprisingly, both groups agreed on the importance of computer skills for recent healthcare administration graduates. In particular, computer skills such as word processing, graphics and presentation, using operating systems, creating and editing databases, spreadsheet analysis, using imported data, e-mail, using electronic bulletin boards, and downloading information were among the highest ranked computer skills necessary for recent graduates. However, there were statistically significant differences in perceptions between senior executives and healthcare administration students as to the extent of computer skills required in areas such as word processing, graphics and presentation, spreadsheet analysis, using imported data, and working with local area networks (LANs).

Computer Literacy↗
PubMed1984

Diffusion of innovation: computer technology in hospital pharmacy.

The diffusion of computer technology in hospital pharmacy departments was studied by surveying pharmacy directors in a randomly selected sample of 501 hospitals in the United States with at least 100 beds. Pharmacy directors were asked to indicate for which of 17 tasks a computer or memory typewriter was used in the pharmacy department. The time of first adopting computers in the department was compared with the predicted S adoption curve; adoption time was also correlated with characteristics of the hospital, pharmacy, and pharmacy director. Of the 417 respondents, 308 reported use of a memory typewriter or computer in the pharmacy. Fifty-one directors reported only memory-typewriter use, and 94 reported both computer and memory-typewriter use. Maintenance of patient census lists and patient billing were the most frequent uses of computers. The primary uses of memory typewriters were preparation of letters and labels. There was no significant difference in the actual and predicted S curves for time of adoption of computers. The number of months since first adopting computers was positively correlated with hospital bed size and the pharmacy director's number of years as a pharmacist, years in current position and with current employer, and number of subordinates; it was also positively correlated with number of pharmaceutical services and number of computer uses in the department. Computer technology is becoming more universally accepted in hospital pharmacy, and research on the diffusion of innovations suggests that acceptance will continue to increase.

Computers↗
PubMed1994

Computers in the consultation: the patient's view.

BACKGROUND: The use of computers in general practice consultations is becoming widespread. AIM: A qualitative study was undertaken to determine how patients in one practice responded to the use of computers, and the issues which particularly concerned them when doctors used computers in the consultation. METHOD: Thirty patients whose age-sex characteristics were proportional to the age-sex distribution of one practice were selected to be interviewed within two weeks of a consultation. The interviews were taped, transcribed and analysed. RESULTS: Patients had seen or used computers in many other places and accepted their role in data management. Patients with more experience of computers were more aware of their limitations, particularly with regard to the possibility of loss of confidentiality. Patients did not think the use of a computer led to a loss of the personal touch in the consultation as long as verbal skills and eye contact were maintained. However, they did expect doctors using computers to have acquired computer skills. All but one patient said they wanted to see what was on the screen, although 11 did not know they had the right to read their notes on the screen. CONCLUSION: Patients regarded the use of computers by their doctors as normal and indicative of the doctors being up to date. Most respondents were concerned about possible loss of confidentiality. This concern, and their expressed preference for computer details to be visible and shared, pose challenges to doctors' technical and communication skills.

Adolescent↗
PubMed2005

A computer services program for residents of a continuing care retirement community: needs assessment and program design.

Preparatory to establishing a computer services program for residents, Presbyterian Homes, a multi-campus continuing care retirement community, conducted an assessment of residents' computer needs, ownership, and usage. Based on the results of the needs assessment, computer resource rooms were established at each facility, with computer hardware and software adapted for the use of seniors. We also deliver adapted computer education for residents, including small-group training in basic software skills; classes on software for computer accessibility; and workshops on themes motivating computer use. Ongoing evaluation shows that half of residents make use of computer resources, and that their computer skills have opened the door to other educational opportunities.

Aged↗
PubMedDate not supplied

Acceptability of computer assessments among ethnically diverse, low-income smokers.

PURPOSE: To examine the acceptability of computer-based assessments among an ethnically diverse, low-income population of primary care patients. Although computers have been used to provide assessments and interventions in health care settings, members of ethnic minority and low-income households have less access to computers than other groups, and therefore the acceptability of computers as a health care assessment and delivery tool needs to be examined. DESIGN: We examined the acceptability of computers for providing assessments of smoking history, nicotine dependence, and other related variables among an ethnically diverse, low-income primary care population. No intervention was used in this study. SETTING: Three inner-city primary care clinics located in hospitals were used as sites for this study. These hospitals were located in areas of the city where low-income and ethnic minority households are overrepresented relative to the total population. SUBJECTS: Adult male and female smokers (n = 522) were recruited while awaiting appointments in each primary care clinic. MEASURES: A questionnaire assessing smoking rate, patterns, history, motivation to quit smoking, and other smoking-related variables was administered using either a paper-and-pencil format or a laptop computer. RESULTS: Frequency counts, analysis of variance, and chi 2 tests were used where appropriate. Most subjects (78.5%) used the computer to complete the baseline survey. Almost all subjects (92%) rated the computer "very easy" or "easy" to use. Subjects who were Spanish-speaking, were born outside the United States, or were Hispanic tended to rate the program as slightly less easy to use than other subjects. CONCLUSIONS: Computer-based assessments appear highly acceptable to individuals in low-income populations.

Adult↗
PubMed2001

Parasitic computing.

Reliable communication on the Internet is guaranteed by a standard set of protocols, used by all computers. Here we show that these protocols can be exploited to compute with the communication infrastructure, transforming the Internet into a distributed computer in which servers unwittingly perform computation on behalf of a remote node. In this model, which we call 'parasitic computing', one machine forces target computers to solve a piece of a complex computational problem merely by engaging them in standard communication. Consequently, the target computers are unaware that they have performed computation for the benefit of a commanding node. As experimental evidence of the principle of parasitic computing, we harness the power of several web servers across the globe, which-unknown to them-work together to solve an NP complete problem.

Journal Article↗
PubMed2005

Quantum computing with realistically noisy devices.

In theory, quantum computers offer a means of solving problems that would be intractable on conventional computers. Assuming that a quantum computer could be constructed, it would in practice be required to function with noisy devices called 'gates'. These gates cause decoherence of the fragile quantum states that are central to the computer's operation. The goal of so-called 'fault-tolerant quantum computing' is therefore to compute accurately even when the error probability per gate (EPG) is high. Here we report a simple architecture for fault-tolerant quantum computing, providing evidence that accurate quantum computing is possible for EPGs as high as three per cent. Such EPGs have been experimentally demonstrated, but to avoid excessive resource overheads required by the necessary architecture, lower EPGs are needed. Assuming the availability of quantum resources comparable to the digital resources available in today's computers, we show that non-trivial quantum computations at EPGs of as high as one per cent could be implemented.

Journal Article↗
PubMed1992

Attitudes and opinions of medical staff towards computers.

The attitudes and opinions of 120 medical staff and 22 medical students towards the use of computers in medicine were assessed through a self-administered questionnaire. More than 60% of the respondents have never used computers. Age, sex, nationality and employment status correlate with computer usage. Students, interns, residents and consultants above 50 years of age have poor attitudes towards computers. This category of respondents believe that computers are important but not essential for medical practice. A higher proportion of those who showed positive attitudes to computers had no prior formal training in computer usage. However, they expressed their desire to attend computer training programs. There is a great need to emphasize automation in the undergraduate and postgraduate medical training to cope with improved technology in the practice of medicine. In fact about 90% of the respondents in this study demanded that computer training and applications be introduced in the medicine curriculum either at undergraduate, postgraduate or both levels.

Attitude to Computers↗
PubMed1990

Brain maps and parallel computers.

It is well known that neural responses in many brain regions are organized in characteristic spatial patterns referred to as brain maps. It is likely that these patterns in some way reflect aspects of the neural computations being performed, but to date there are no general guiding principles for relating the structure of a brain map to the properties of the associated computation. In the field of parallel computing, maps similar to brain maps arise when computations are distributed across the multiple processors of a parallel computer. In this case, the relationship between maps and computations is well understood and general principles for optimally mapping computations onto parallel computers have been developed. In this paper we discuss how these principles may help illuminate the relationship between maps and computations in the nervous system.

Brain↗
PubMed2006

Patient-directed intelligent and interactive computer medical history-gathering systems: a utility and feasibility study in the emergency department.

INTRODUCTION: Patients can be used as a resource to enter their own pertinent medical information. This study will evaluate the feasibility of an intelligent computer medical history-taking device directed at patients in the emergency department (ED). METHODS: Two of the authors (MB, RE) developed an expert system that can take patient-directed medical histories. Patients interacted with the computer in the ED waiting room while it gathered a medical history based on chief complaint (CC). A survey was completed post history. A sub-study assessed the computer's ability to take an adequate history for an index CC. We compared the computer and emergency physician histories for the presence or absence of important historical elements. RESULTS: Sixty-seven patients used the interactive computer system. The mean time to complete the history was 5 min and 32s +/- 1 min and 21s. The patient response rate was 97%. Over 83% felt that the computer was very easy to use and over 92% would very much use the computer again. A total of 15 patients with abdominal pain (index CC) were evaluated for the sub-study. The computer history asked 90+/-7%, and the emergency physician asked 55+/-18%, of the important historical elements. These groups were statistically different with a p-value of <0.00001. CONCLUSION: This feasibility study has shown that the computer history-taking device is well accepted by patients and that such a system can be integrated into the normal process of patient triage without delaying patient care. Such a system can serve as an initial mode for documentation and data acquisition directly from the patient.

Adult↗
PubMed1996

Mediastinal lymph node staging of non-small-cell lung cancer: a prospective comparison of computed tomography and positron emission tomography.

We compared the abilities of positron emission tomography and computed tomography to detect N2 or N3 lymph node metastases (N2 or N3) in patients with lung cancer. Positron emission tomography detects increased rates of glucose uptake, characteristic of malignant cells. Patients with peripheral tumors smaller than 2 cm and a normal mediastinum were ineligible. All patients underwent computed tomography, positron emission tomography, and surgical staging. The American Thoracic Society lymph node map was used. Computed and positron emission tomographic scans were read by separate radiologists blinded to surgical staging results. Lymph nodes were "positive" by computed tomography if larger than 1.0 cm in short-axis diameter. Standardized uptake values were recorded from areas on positron emission tomography corresponding to those from which biopsy specimens were taken; if greater than 4.2, they were called "positive." Seventy-five lymph node stations (2.8 per patient) were analyzed in 27 patients. Computed tomography incorrectly staged the mediastinum as positive for metastases in three patients and as negative for metastases in three patients. Sensitivity and specificity of computed tomographic scans were 67% and 83%, respectively. Positron emission tomography correctly staged the mediastinum in all 27 patients. When analyzed by individual node station, there were four false positive and four false negative results by computed tomography (sensitivity = 60%, specificity = 93%, positive predictive value = 60%). Positron emission tomography mislabeled one node station as positive (100% sensitive, 98% specific, positive predictive value 91%). The differences were significant when the data were analyzed both for individual lymph node stations (p = 0.039) and for patients (p = 0.031) (McNemar test). Positron emission tomography and computed tomography are more accurate than computed tomography alone in detecting mediastinal lymph node metastases from non-small-cell lung cancer.

Adult↗
PubMed2003

Continuing challenges for computer-based neuropsychological tests.

A number of issues critical to the development of computer-based neuropsychological testing systems that remain continuing challenges to their widespread use in occupational and environmental health are reviewed. Several computer-based neuropsychological testing systems have been developed over the last 20 years, and they have contributed substantially to the study of neurologic effects of a number of environmental exposures. However, many are no longer supported and do not run on contemporary personal computer operating systems. Issues that are continuing challenges for development of computer-based neuropsychological tests in environmental and occupational health are discussed: (1) some current technological trends that generally make test development more difficult; (2) lack of availability of usable speech recognition of the type required for computer-based testing systems; (3) implementing computer-based procedures and tasks that are improvements over, not just adaptations of, their manually-administered predecessors; (4) implementing tests of a wider range of memory functions than the limited range now available; (5) paying more attention to motivational influences that affect the reliability and validity of computer-based measurements; and (6) increasing the usability of and audience for computer-based systems. Partial solutions to some of these challenges are offered. The challenges posed by current technological trends are substantial and generally beyond the control of testing system developers. Widespread acceptance of the "tablet PC" and implementation of accurate small vocabulary, discrete, speaker-independent speech recognition would enable revolutionary improvements to computer-based testing systems, particularly for testing memory functions not covered in existing systems. Dynamic, adaptive procedures, particularly ones based on item-response theory (IRT) and computerized-adaptive testing (CAT) methods, will be implemented in new tests that will be more efficient, reliable, and valid than existing test procedures. These additional developments, along with implementation of innovative reporting formats, are necessary for more widespread acceptance of the testing systems.

Computer Systems↗