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Computer and information networks.

The most basic conclusion coming out of the EDUCOM seminars is that computer networking must be acknowledged as an important new mode for obtaining information and computation (15). It is a real alternative that needs to be given serious attention in current planning and decision-making. Yet the fact is that many institutions are not taking account of networks when they confer on whether or how to replace their main computer. Articulation of the possibilities of computer networks goes back to the early 1960's and before, and working networks have been in evidence for several years now, both commercially and in universities. What is new, however, is the unmistakable recognition-bordering on a sense of the inevitable-that networks are finally practical and here to stay. The visionary and promotional phases of computer networks are over. It is time for hard-nosed comparative analysis (16). Another conclusion of the seminars has to do with the factors that hinder the fuller development of networking. The major problems to be overcome in applying networks to research and education are political, organizational, and economic in nature rather than technological. This is not to say that the hardware and software problems of linking computers and information systems are completely solved, but they are not the big bottlenecks at present. Research and educational institutions must find ways to organize themselves as well as their computers to work together for greater resource sharing. The coming of age of networks takes on special significance as a result of widespread dissatisfactions expressed with the present computing situation. There is a feeling that the current mode of autonomous, self-sufficient operation in the provision of computing and information services is frequently wasteful, deficient, and unresponsive to users' needs because of duplication of effort from one installation to another, incompatibilities, and inadequate documentation, program support, and user assistance. Complaints about the relative lack of uniform standards and the paucity of information on what programs and data are available and how to get and use them are commonplace. The human tendency, when beset by problems such as these, is to seek a savior in the next new technology-networks in this case. But networking does not in and of itself offer a solution to current deficiencies. What it does offer is a promising vehicle with which to bring about important changes in user practices, institutional procedures, and government policy that can lead to effective solutions. Thus more critical than whether networking is developed and applied is how it is developed and applied. For example, networking emphasizes the need for standards and good documentation. Unless effective mechanisms are developed and strong measures taken in networking to ensure that suitable standards and documentation are developed, present inadequacies could get worse, not better.

Computers↗

Immediate computed tomography or admission for observation after mild head injury: cost comparison in randomised controlled trial.

OBJECTIVE: To compare the costs of immediate computed tomography during triage for admission with those of observation in hospital in patients with mild head injury. DESIGN: Prospective cost effectiveness analysis within a multicentre, pragmatic randomised trial. SETTING: 39 acute hospitals in Sweden PARTICIPANTS: 2602 patients (aged > or = 6) with mild head injury. INTERVENTIONS: Immediate computed tomography or admission for observation. MAIN OUTCOME MEASURES: Direct and indirect costs related to the mild head injury during the acute and three month follow-up period. RESULTS: Outcome after three months was similar for both strategies (non-significantly in favour of computed tomography). For the acute stage and complications, the cost was 461 euros (314 pounds sterling, 582 dollars) per patient in the computed tomography group and 677 euros (462 pounds sterling, 854 dollars) in the observation group; an average of 32% less in the computed tomography group (216 euros, 95% confidence interval -272 to -164; P < 0.001). Sensitivity analysis showed that computed tomography was the most cost effective strategy under a broad range of assumptions. After three months, total costs were 718 euros and 914 euros per patient-that is, 196 euros less in the computed tomography group (- 281 to - 114; P < 0.001). The lower cost of the computed tomography strategy at the acute stage thus remained unchanged during follow-up. CONCLUSION: Patients with mild head injury attending an emergency department can be managed more cost effectively with computed tomography rather than admission for observation in hospital. TRIAL REGISTRATION: ISRCTN81464462.

Adolescent↗

Impact of a computer-based patient record system on data collection, knowledge organization, and reasoning.

OBJECTIVE: To assess the effects of a computer-based patient record system on human cognition. Computer-based patient record systems can be considered "cognitive artifacts," which shape the way in which health care workers obtain, organize, and reason with knowledge. DESIGN: Study 1 compared physicians' organization of clinical information in paper-based and computer-based patient records in a diabetes clinic. Study 2 extended the first study to include analysis of doctor-patient-computer interactions, which were recorded on video in their entirety. In Study 3, physicians' interactions with computer-based records were followed through interviews and automatic logging of cases entered in the computer-based patient record. RESULTS: Results indicate that exposure to the computer-based patient record was associated with changes in physicians' information gathering and reasoning strategies. Differences were found in the content and organization of information, with paper records having a narrative structure, while the computer-based records were organized into discrete items of information. The differences in knowledge organization had an effect on data gathering strategies, where the nature of doctor-patient dialogue was influenced by the structure of the computer-based patient record system. CONCLUSION: Technology has a profound influence in shaping cognitive behavior, and the potential effects of cognition on technology design needs to be explored.

Cognition↗

Should office workers spend fewer hours at their computer? A systematic review of the literature.

Worldwide, millions of office workers use a computer. Reports of adverse health effects due to computer use have received considerable media attention. This systematic review summarises the evidence for a relationship between the duration of work time spent using the computer and the incidence of hand-arm and neck-shoulder symptoms and disorders. Several databases were systematically searched up to 6 November 2005. Two reviewers independently selected articles that presented a risk estimate for the duration of computer use, included an outcome measure related to hand-arm or neck-shoulder symptoms or disorders, and had a longitudinal study design. The strength of the evidence was based on methodological quality and consistency of the results. Nine relevant articles were identified, of which six were rated as high quality. Moderate evidence was concluded for a positive association between the duration of mouse use and hand-arm symptoms. For this association, indications for a dose-response relationship were found. Risk estimates were in general stronger for the hand-arm region than for the neck-shoulder region, and stronger for mouse use than for total computer use and keyboard use. A pathophysiological model focusing on the overuse of muscles during computer use supports these differences. Future studies are needed to improve our understanding of safe levels of computer use by measuring the duration of computer use in a more objective way, differentiating between total computer use, mouse use and keyboard use, attaining sufficient exposure contrast, and collecting data on disability caused by symptoms.

Arm↗

Student perceptions and learning outcomes of computer-assisted versus traditional instruction in physiology.

This study compared student perceptions and learning outcomes of computer-assisted instruction against those of traditional didactic lectures. Components of Quantitative Circulatory Physiology (Biological Simulators) and Mechanical Properties of Active Muscle (Trinity Software) were used to teach regulation of tissue blood flow and muscle mechanics, respectively, in the course Medical Physiology. These topics were each taught, in part, by 1) standard didactic lectures, 2) computer-assisted lectures, and 3) computer laboratory assignment. Subjective evaluation was derived from a questionnaire assessing student opinions of the effectiveness of each method. Objective evaluation consisted of comparing scores on examination questions generated from each method. On a 1-10 scale, effectiveness ratings were higher (P < 0.0001) for the didactic lectures (7.7) compared with either computer-assisted lecture (3.8) or computer laboratory (4.2) methods. A follow-up discussion with representatives from the class indicated that students did not perceive computer instruction as being time effective. However, examination scores from computer laboratory questions (94.3%) were significantly higher compared with ones from either computer-assisted (89.9%; P < 0.025) or didactic (86.6%; P < 0.001) lectures. Thus computer laboratory instruction enhanced learning outcomes in medical physiology despite student perceptions to the contrary.

Adult↗

An assessment of computer use, knowledge, and attitudes of diabetes educators.

A questionnaire to survey attitudes, use, and knowledge of computers was sent to 816 randomly selected members of AADE to determine the degree to which currently available computer resources are used in diabetes education and to investigate the need for future computing resources designed to support diabetes education. Analysis of the data showed that even diabetes educators who use computers infrequently have a generally favorable attitude toward them. Highest use of computers is in noneducational applications, mostly for word processing and record keeping. Most respondents believe that computers have yet to make a major contribution to the teaching and learning process in diabetes education, and few felt adequately prepared for creative use or development of computer applications. Increasing the role of computers in support of patient education will require encouragement and demonstrations of computer efficacy from health care institutions and professional organizations.

Adult↗

Perceptions about computers and the internet in a pediatric clinic population.

BACKGROUND: A digital divide with respect to computer and Internet access has been noted in numerous studies and reports. Equally important to ownership is comfort with computers and Internet technology, and concerns about privacy of personal data. OBJECTIVE: To measure how households in a pediatric clinic vary in their attitudes toward computers, concerns about Internet confidentiality, and comfort using the Internet and whether these views are associated with household income or education. DESIGN/METHODS: A phone survey was administered to a population-based sample of parents with children aged 0 to 11 years. All children received medical care from a community-based clinic network serving patients in King County, Wash. RESULTS: Eighty-eight percent of respondents used a computer once a week or more, and 83% of respondents reported favorable feelings toward computers. Although 97% of respondents were willing to share personal information over the Internet, many respondents considered data security important. While household income and parental education were associated with comfort and familiarity with computers, the effect is small. Respondents who already owned a computer and had Internet access did not differ in their perceptions according to socioeconomic or educational attainment. CONCLUSIONS: Most families like using computers and feel comfortable using the Internet regardless of socioeconomic status. Fears about the digital divide's impact on the attitudes of parents toward computers or their comfort using the Internet should not be seen as a barrier to developing Internet-based health interventions for a pediatric clinic population.

Adult↗

The accuracy of computed tomography for the diagnosis of tibial nonunion.

BACKGROUND: When a patient is seen with a possible tibial nonunion and equivocal findings on plain radiographs, the surgeon may choose to obtain a computed tomography scan to better delineate the bone anatomy. However, the sensitivity and specificity of computed tomography in this setting is not known. We investigated the accuracy of computed tomography for detecting nonunion in this clinical situation. METHODS: Thirty-five patients with equivocal findings on plain radiographs underwent computed tomography scanning. The patients were first seen at an average of 9.7 months after the injury and had undergone a mean of 2.6 prior operations. A so-called gold standard of union or nonunion was determined by either surgical findings (for twenty-five patients who were operatively treated) or six months of clinical observation (for ten patients who had nonoperative treatment). Computed tomography scans were assessed by two radiologists and one orthopaedic surgeon who were blinded to the clinical outcome. RESULTS: Computed tomography scans displayed very good diagnostic accuracy. Intraobserver agreement was high (intraclass correlation coefficient = 0.89), the sensitivity for detecting nonunion was 100%, and the overall accuracy was 89.9%. Computed tomography was limited by a low specificity of 62%, as three patients who were diagnosed as having tibial nonunion with computed tomography underwent surgery and were found to have a healed fracture. CONCLUSIONS: Computed tomography displays very good accuracy in the evaluation of tibial fracture-healing. However, it is limited by low specificity and may sometimes misrepresent a healed fracture as a nonunion. Surgeons must be aware of this pitfall in order to accurately determine which patients need surgical intervention.

Adult↗

Two and three-dimensional computed tomography for the classification and management of distal humeral fractures. Evaluation of reliability and diagnostic accuracy.

BACKGROUND: Complex fractures of the distal part of the humerus can be difficult to characterize on plain radiographs and two-dimensional computed tomography scans. We tested the hypothesis that three-dimensional reconstructions of computed tomography scans improve the reliability and accuracy of fracture characterization, classification, and treatment decisions. METHODS: Five independent observers evaluated thirty consecutive intra-articular fractures of the distal part of the humerus for the presence of five fracture characteristics: a fracture line in the coronal plane; articular comminution; metaphyseal comminution; the presence of separate, entirely articular fragments; and impaction of the articular surface. Fractures were also classified according to the AO/ASIF Comprehensive Classification of Fractures and the classification system of Mehne and Matta. Two rounds of evaluation were performed and then compared. Initially, a combination of plain radiographs and two-dimensional computed tomography scans (2D) were evaluated, and then, two weeks later, a combination of radiographs, two-dimensional computed tomography scans, and three-dimensional reconstructions of computed tomography scans (3D) were assessed. RESULTS: Three-dimensional computed tomography improved both the intraobserver and the interobserver reliability of the AO classification system and the Mehne and Matta classification system. Three-dimensional computed tomography reconstructions also improved the intraobserver agreement for all fracture characteristics, from moderate (average kappa [kappa2D] = 0.554) to substantial agreement (kappa3D = 0.793). The addition of three-dimensional images had limited influence on the interobserver reliability and diagnostic characteristics (sensitivity, specificity, and accuracy) for the recognition of specific fracture characteristics. Three-dimensional computed tomography images improved intraobserver agreement (kappa2D = 0.62 compared with kappa3D = 0.75) but not interobserver agreement (kappa2D = 0.24 compared with kappa3D = 0.28) for treatment decisions. CONCLUSIONS: Three-dimensional reconstructions improve the reliability, but not the accuracy, of fracture classification and characterization. The influence of three-dimensional computed tomography was much more notable for intraobserver comparisons than for interobserver comparisons, suggesting that different observers see different things in the scans-most likely a reflection of the training, knowledge, and experience of the observer with regard to these relatively uncommon and complex injuries.

Adult↗

Establishing a communications link between two different, incompatible, personal computers: with practical examples and illustrations and program code.

The increasing need to communicate to exchange data can be handled by personal microcomputers. The necessity for the transference of information stored in one type of personal computer to another type of personal computer is often encountered in the process of integrating multiple sources of information stored in different and incompatible computers in Medical Research and Practice. A practical example is demonstrated with two relatively inexpensive commonly used computers, the IBM PC jr. and the Apple IIe. The basic input/output (I/O) interface chip for serial communication for each computer are joined together using a Null connector and cable to form a communications link. Using BASIC (Beginner's All-purpose Symbolic Instruction Code) Computer Language and the Disk Operating System (DOS) the communications handshaking protocol and file transfer is established between the two computers. The BASIC programming languages used are Applesoft (Apple Personal Computer) and PC BASIC (IBM Personal computer).

Computers↗

Computer anxiety in nursing students.

The purpose of the study was to estimate the prevalence and severity of computer anxiety in beginning AD and BS nursing students and to determine the effect of hands-on computer experience on computer anxiety. The sample consisted of 272 volunteer subjects from five schools of nursing in a central southern state. Computer anxiety was measured using the Computer Anxiety Index by Maurer and Simonson. Factor analysis of the index was carried out to provide construct validity for the tool. Twenty-one percent of the subjects were found to have high computer anxiety. No significant difference in computer anxiety was demonstrated between associate degree (AD) and baccalaureate (BS) students. However, subjects with more hands-on computer experience had significantly less computer anxiety.

Adolescent↗

Single photon emission computed tomography procedure improves accuracy of somatostatin receptor scintigraphy in gastro-entero pancreatic tumours.

In patients with gastro-enteropancreatic neuroendocrine tumours the localization of all the neoplastic lesions and an accurate staging of the diseases have important therapeutic implications. Somatostatin receptor scintigraphy with In-111 pentatreotide has proved to be useful in detecting gastro-enteropancreatic tumours; however, the role of abdominal single photon emission computed tomography has not yet been definitively established. In a series of 52 patients with gastro-enteropancreatic tumours (9 non-functioning islet cell carcinomas, 4 insulinomas, 3 somatostatinomas, 2 VIPomas, 1 glucagonoma and 33 carcinoids) we compared somatostatin receptor scintigraphy with the results of computed tomography and magnetic resonance imaging performed within one month. Four and 24-hour total body planar images and 4-hour abdominal single photon emission computed tomography were acquired after the i.v. injection of approximately 250 MBq of In-111 pentatreotide. Only abdominal localizations were considered: planar scans detected 16 extrahepatic lesions in 13 patients and 54 liver sites in 21 patients; single photon emission computed tomography visualized 31 extrahepatic lesions and 89 liver metastases in 27 and 28 patients, respectively; computed tomography and magnetic resonance imaging detected 11 extrahepatic lesions in 10 patients and 73 liver sites in 21 patients. In-111 pentatreotide single photon emission computed tomography was the only imaging method able to localize tumoural lesions in 13 patients; all these localizations were then histologically verified. The scintigraphic positivity did not depend on the site or on the presence of hormonal hypersecretions. In conclusion, our results indicate that single photon emission computed tomography is more sensitive than planar images and computed tomography/magnetic resonance imaging in detecting abdominal gastro-enteropancreatic tumours and their metastases; it is able to increase both the number of visualized lesions and that of patients with positive findings. Single photon emission computed tomography is particularly useful in patients in whom tumoural lesions have not been already localized; it should be the first imaging modality in patients with gastro-enteropancreatic tumours: its initial use will result in more information and proper management.

Female↗

The Columbia Registry of Controlled Clinical Computer Trials.

Numerous reports on randomized controlled clinical trials of computer-based interventions have been published. These trials provide useful evaluations of the impact of information technology on patient care. Unfortunately, several obstacles make access to the trial reports difficult. Barriers include the large variety of publications in which reports may appear, non-standard descriptors, and incomplete indexing. Some analyzers indicate inadequate testing of computer methods. The purpose of establishing a registry of randomized controlled clinical computer trials was to assist the identification of computer services with demonstrated ability to improve the process or outcome of patient care. A report collection, selection, information extraction, and registration method was developed and implemented. One hundred and six reports on computer trials have been collected. A large variety of computer-assisted interventions have been tested in the registered trials (40% reminder, 15% feedback, 14% dose planning, 14% patient education, 12% medical record). 76% of the registered reports were published in the United States and most of the remainder in various European countries. In reporting computer trial results, 77% of the authors did not use both the "computer" and "trial" keywords in the title or abstract of their papers. We conclude that a major obstacle to adequate computer technology assessment is inadequate access to the published results.

Computer-Assisted Instruction↗

Factors leading to the Computer Vision Syndrome: an issue at the contemporary workplace.

INTRODUCTION: Vision and eye related problems are common among computer users, and have been collectively called the Computer Vision Syndrome (CVS). METHODS: An observational study in order to identify the risk factors leading to the CVS was done. Twenty-eight participants answered a validated questionnaire, and had their workstations examined. The questionnaire evaluated personal, environmental, ergonomic factors, and physiologic response of computer users. The distance from the eye to the computers' monitor (A), the computers' monitor height (B), and visual axis height (C) were measured. The difference between B and C was calculated and labeled as D. Angles of gaze to the computer monitor were calculated using the formula: angle=tan(-1)(D/ A). Angles were divided into two groups: participants with angles of gaze ranging from 0 degrees to 13.9 degrees were included in Group 1; and participants gazing at angles larger than 14 degrees were included in Group 2. Statistical analysis of the evaluated variables was made. RESULTS: Computer users in both groups used more tear supplements (as part of the syndrome) than expected. This association was statistically significant (p<0.10). Participants in Group 1 reported more pain than participants in Group 2. Associations between the CVS and other personal or ergonomic variables were not statistically significant. CONCLUSIONS: Our findings show that most important factor leading to the syndrome is the angle of gaze at the computer monitor. Pain in computer users is diminished when gazing downwards at angles of 14 degrees or more. The CVS remains an under estimated and poorly understood issue at the workplace. The general public, health professionals, the government, and private industries need to be educated about the CVS.

Adult↗

Nurses' attitudes towards computers: cross sectional questionnaire study.

AIM: To estimate the attitudes of hospital nurses towards computers and the influence of gender, age, education, and computer usage on these attitudes. METHODS: The study was conducted in two Croatian hospitals where integrated hospital information system is being implemented. There were 1,081 nurses surveyed by an anonymous questionnaire consisting of 8 questions about demographic data, education, and computer usage, and 30 statements on attitudes towards computers. The statements were adapted to a Likert type scale. Differences in attitudes towards computers were compared using one-way ANOVA and Tukey-b post-hoc test. RESULTS: The total score was 120+/-15 (mean+/-standard deviation) out of maximal 150. Nurses younger than 30 years had a higher total score than those older than 30 years (124+/-13 vs 119+/-16 for 30-39 age groups and 117+/-15 for>39 age groups, P<0.001). Nurses with a bachelor's degree (119+/-16 vs 122+/-14, P=0.002) and nurses who had attended computer science courses had a higher total score compared to the others (124+/-13 vs 118+/-16, P<0.001). Nurses using computers more than 5 hours per week had higher total score than those who used computers less than 5 hours (127+/-13 vs 124+/-12 for 1-5 h and and 119+/-14 for <1 hour per day, P<0.001, post-hoc test). CONCLUSION: Nurses in general have positive attitudes towards computers. These results are important for the planning and implementing an integrated hospital information system.

Adult↗

Efficacy of computer-assisted management of respiratory failure in neonates.

We modified an algorithm for mechanical ventilation of infants with respiratory distress syndrome to create an interactive user-friendly computer program. To determine the effectiveness of this computer program, we evaluated the correction of deranged arterial blood gases in three groups of neonates: group I, treated before the introduction of the computer into the nursery; group II, managed by pediatric residents with the guidance of the computer program; group III, treated after the introduction of the computer into the nursery but managed without consideration of the computer output. Arterial blood gas values improved more frequently in the neonates managed with computer consultation (group II, 65/75, 87%) than in both control groups (group I, 37/57, 65%, P less than .005; and group III, 46/63, 73%, P less than .05). Furthermore, increases in ventilatory support in the presence of normal arterial blood gas values occurred only in patients managed without computer guidance. In a teaching institution, more effective care of neonates with respiratory failure may be facilitated by computer-assisted management of mechanical ventilators.

Blood Gas Analysis↗

Are patients pleased with computer use in the examination room?

BACKGROUND: As computer hardware becomes less expensive and computer software more sophisticated and easy to use, more physicians are using computers to take notes and keep records. Although computer use offers many benefits, there is concern about whether the use of computers in the examination room will interfere with the patient-physician relationship. This experiment surveyed patient satisfaction following examination by either of two physicians, one using pen-and-pencil note-taking, the other taking notes on a computer. METHODS: Sixty patients consented to participate in this prospective, randomized, crossover study. In the first phase, 15 randomly selected patients were examined by Physician A, who made a written record, and 15 by Physician B, who made a computer record. In the second phase, the physicians switched roles. After the examination, patients completed a questionnaire to assess their degree of satisfaction. RESULTS: There were no significant differences in satisfaction between the group whose physician made a handwritten record as compared with those whose physician used a computer, nor was there an interaction between type of note-taking and physician. There was also no correlation between patient satisfaction and previous patient exposure to and use of computers. CONCLUSIONS: This study demonstrated no decrease in patient satisfaction when a computerized patient record was introduced.

Adult↗

Comparison of measured and computed epicardial potentials from a patient-specific inverse model.

This study reports the first direct comparison of measured and computed epicardial potentials in which the specific anatomy of a test subject has been used to calculate the inverse electrocardiographic model. It is now feasible to obtain low-noise body surface potential maps and to incorporate accurate anatomic data into inverse procedures for the purpose of computing epicardial potential distributions. The direct verification of computed human epicardial distributions remains an important goal. The experiment reported here obtained direct measurements from six transcutaneous pacing wires that were attached to points on the epicardial surface of the human heart in an intact subject. From the same subject, a magnetic resonance scan was used to produce a specific thoracic model consisting of 5-mm cubes. The forward model uses the finite difference method to compute a forward transfer matrix that relates each of 26 epicardial regions to body surface measurements. The inverse computation was performed by zero-order Tikhonov regularization. Body surface potentials were used in the inverse procedure to compute epicardial potentials, which were then compared with direct epicardial measurements. The computed epicardial potentials were compared to the measured ones by correlation, which gave an amplitude-independent measure of similarity. Amplitude differences and time delays in computed potentials were observed, but the morphologic trend was generally well recovered. The results obtained indicate the sensitivity of the inverse model to a number of factors. The robustness of computed epicardial distributions to errors in assumed lung conductivity is shown. Results from a nonpatient-specific, but realistic, torso model are presented.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Pacing, Artificial↗