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PubMed1988

Do personal computers make doctors less personal?

Ten months after the installation of a computer in a general practice surgery a postal survey (piloted questionnaire) was sent to 390 patients. The patients' views of their relationship with their doctor after the computer was introduced were compared with their view of their relationship before the installation of the computer. More than 96% of the patients (n = 263) stated that contact with their doctor was as easy and as personal as before. Most stated that the computer did not influence the duration of the consultation. Eighty one patients (30%) stated, however, that they thought that their privacy was reduced. Unlike studies of patients' attitudes performed before any actual experience of use of a computer in general practice, this study found that patients have little difficulty in accepting the presence of a computer in the consultation room. Nevertheless, doctors should inform their patients about any connections between their computer and other, external computers to allay fears about a decrease in privacy.

Attitude to Computers↗
PubMed1999

Computer support for determining drug dose: systematic review and meta-analysis.

OBJECTIVE: To review the effectiveness of computer support for determining optimum drug dose. DESIGN: Systematic review of comparative studies where computers gave advice to clinicians on the most appropriate drug dose. Search methods used were standard for the Cochrane Collaboration on Effective Professional Practice. SUBJECTS: Comparative studies conducted worldwide and published between 1966 and 1996. MAIN OUTCOME MEASURES: For qualitative review, relative percentage differences were calculated to compare effects of computer support in different settings. For quantitative data, effect sizes were calculated and combined in meta-analyses. RESULTS: Eighteen studies met the inclusion criteria. The drugs studied were theophylline, warfarin, heparin, aminoglycosides, nitroprusside, lignocaine, oxytocin, fentanyl, and midazolam. The computer programs used individualised pharmacokinetic models to calculate the most appropriate dose. Meta-analysis of data from 671 patients showed higher blood concentrations of drug with computer support (effect size 0.69, 95% confidence interval 0.36 to 1.02) and reduced time to achieve therapeutic control (0.44, 0.17 to 0.71). The total dose of drug used was unchanged, and there were fewer unwanted effects of treatment. Five of six studies measuring outcomes of care showed benefit from computer assistance. CONCLUSIONS: This review suggests that using computers to determine the correct dose of certain drugs in acute hospital settings is beneficial. Computers may give doctors the confidence to use higher doses when necessary, adjusting the drug dose more accurately to individual patients. Further research is necessary to evaluate the benefits in general use.

Decision Making, Computer-Assisted↗
PubMed1999

Randomised trial of personalised computer based information for cancer patients.

OBJECTIVE: To compare the use and effect of a computer based information system for cancer patients that is personalised using each patient's medical record with a system providing only general information and with information provided in booklets. DESIGN: Randomised trial with three groups. Data collected at start of radiotherapy, one week later (when information provided), three weeks later, and three months later. PARTICIPANTS: 525 patients started radical radiotherapy; 438 completed follow up. INTERVENTIONS: Two groups were offered information via computer (personalised or general information, or both) with open access to computer thereafter; the third group was offered a selection of information booklets. OUTCOMES: Patients' views and preferences, use of computer and information, and psychological status; doctors' perceptions; cost of interventions. RESULTS: More patients offered the personalised information said that they had learnt something new, thought the information was relevant, used the computer again, and showed their computer printouts to others. There were no major differences in doctors' perceptions of patients. More of the general computer group were anxious at three months. With an electronic patient record system, in the long run the personalised information system would cost no more than the general system. Full access to booklets cost twice as much as the general system. CONCLUSIONS: Patients preferred computer systems that provided information from their medical records to systems that just provided general information. This has implications for the design and implementation of electronic patient record systems and reliance on general sources of patient information.

Attitude to Computers↗
PubMed1995

In pursuit of computer literacy in health management education.

Computer literacy skills are essential tools students must possess to do well in computer-related and quantitative courses, and to be effective health managers. Many health management education programs are faced with the challenge of finding an ideal framework for teaching computer literacy courses. Recently, Austin and Malec (1990) proposed an instructional method for teaching computer literacy. This method was used for three consecutive semesters to teach the computer literacy course offered at Sangamon State University. A case analysis technique was utilized to assess of the effectiveness of this method. A pre-test and post-test design was used in the study. Post-test scores were found to be significantly higher than pre-test scores. Improvements in students' attitudes toward computers were noticed in the areas pertaining to how they view their competency levels. Overall, the data for this study suggest that this instructional method is effective for teaching computer literacy to adult students who have had limited exposure to computers.

Attitude to Computers↗
PubMed2000

Equivalency of computer-based and paper-and-pencil testing.

This study examined the equivalence of computer- and paper-based versions of an examination through score differences across the two test formats as well as students' attitudes toward and perceptions of computer-based examinations. Thirty senior dental hygiene students were randomly divided into two equal groups. One took the first examination on computer, while the second took it on paper. Later, the groups were switched for a second examination. In completing the computer version, each student was asked to complete a survey that examined his or her experience with as well as attitude and perceptions toward computer-based testing. Students using the computer performed as well as or better than those using paper; the increase in performance was significant for the first examination (p < 0.05). Student acceptance of the computer format was mixed, possibly varying with prior exposures to such formats. Benefits of the computer-based examination included reduction in time required for scoring and recording of grades, quicker student progression through the examinations afforded by the digitizing of the visuals, and ease of item analysis for both individual students and the group.

Analysis of Variance↗
PubMed2002

Utilization of computer technology by family medicine community preceptors in Mississippi.

BACKGROUND: Medical informatics require physicians to synthesize information available from a broad range of sources and identify "best" treatment strategies based upon individual patient's needs. METHODS: An assessment of computer technology utilization and the self-perceived competency of the family medicine preceptors who supervise residents during rotations was completed. A ten item survey was developed which assessed the preceptors' comfort level and use of computer technology within their office practices. Surveys were mailed to 127 family medicine preceptors. RESULTS: Sixty-six respondents completed the survey for a response rate of 52%. The majority of respondents indicated ownership of a desktop computer (88%). Forty-nine respondents (77%) indicated general comfort using the computer. Seventeen respondents (27%) used the computers for patient education and nine (14%) utilized the computers in student/resident teaching. CONCLUSIONS: Physicians are not using computers for patient education nor student/resident training. Community preceptors need further training in medical informatics and advanced computer competency.

Computer Literacy↗
PubMed2003

Probabilistic graphical models for computational biomedicine.

BACKGROUND: As genomics becomes increasingly relevant to medicine, medical informatics and bioinformatics are gradually converging into a larger field that we call computational biomedicine. OBJECTIVES: Developing a computational framework that is common to the different disciplines that compose computational biomedicine will be a major enabler of the further development and integration of this research domain. METHODS: Probabilistic graphical models such as Hidden Markov Models, belief networks, and missing-data models together with computational methods such as dynamic programming, Expectation-Maximization, data-augmentation Gibbs sampling, and the Metropolis-Hastings algorithm provide the tools for an integrated probabilistic approach to computational biomedicine. RESULTS AND CONCLUSIONS: We show how graphical models have already found a broad application in different fields composing computational biomedicine. We also indicate several challenges that lie at the interface between medical informatics, statistical genomics, and bioinformatics. We also argue that graphical models offer a unified framework making it possible to integrate in a statistically meaningful way multiple models ranging from the molecular level to cellular and to clinical levels. Because of their versatility and firm statistical underpinning, we assert that probabilistic graphical models can serve as the lingua franca for many computationally intensive approaches to biology and medicine. As such, graphical models should be a foundation of the curriculum of students in these fields. From such a foundation, students could then build towards specific computational methods in medical informatics, medical image analysis, statistical genetics, or bioinformatics while keeping the communication open between these areas.

Computational Biology↗
PubMedDate not supplied

Computer use among medical students in an institution in southern India.

BACKGROUND: This cross-sectional, descriptive study was conducted in Pondicherry from May to October 2002 to assess computer and internet use among medical students. METHODS: The participants were four batches of undergraduate students, one batch of interns and two batches of postgraduate students. A pre-tested questionnaire was used to collect data from 394 subjects. Written informed consent was obtained from all the participants. RESULTS: Computer knowledge was found to be higher among postgraduates (93.3%) compared to undergraduates (84.5%). Students learnt computers by self-learning, attending classes and using manuals. Writing letters was the most common use of the computer (postgraduates [100%] and undergraduates [87.5%]). Seventy-one per cent of the postgraduates and 43% of the undergraduates used English language dictionaries. About 61% of the undergraduates used computers for playing games. Students also used computer for watching movies. MS Office was the most commonly used software (postgraduates [100%] and undergraduates [72.2%]). The use of software for visual designing and drawing was low. Undergraduates used audio players more often than postgraduates. Most students used the internet for e-mail (postgraduates [100%] and undergraduates [97.3%]). Undergraduate students used the internet for chatting and entertainment. Online banking was also used to some extent. Most of the students were willing to undergo training. All the groups unanimously felt that the institute should provide free training in medical informatics. CONCLUSION: This study revealed high computer use among medical students in an institution with good computer facilities. The majority expressed their willingness to undergo further training.

Computer Literacy↗
PubMedDate not supplied

How family physicians choose an office computer system.

BACKGROUND: Purchasing an office computer can be time consuming and frustrating. Financial costs and time demands make it difficult for the family physician, especially in solo practice, to follow the many recommendations offered in the literature. The purpose of this study was to identify the most helpful selection factors used by family physicians who had already purchased an office computer. METHODS: In May 1990 an 18-item questionnaire was mailed to a random sample of 26 percent of the 1167 active members of the Washington Academy of Family Physicians. A final response rate of 45 percent was achieved. Twenty-three percent of the nonresponders were contacted to obtain information about practice demographics and office computer status. RESULTS: Seventy-three percent of responders reported using a computer in their practice. The mean cost ranged from $17,300 for solo practitioners to $55,000 for multispecialty groups. Respondents who reported performing a prepurchase needs assessment, involving the office staff in the decision process, and making cost comparisons were more satisfied with their computer systems than those who did not (P less than 0.05). Satisfaction and acceptance were lower and negatively related to an increasing amount of time needed for the system to become fully operational (P less than 0.01). The level of involvement by the practitioner in the decision process was highly predictive of satisfaction with a computer system: those physicians who were most involved were also the most satisfied. CONCLUSIONS: Family physicians responsible for selecting an office computer for their practices are advised to become personally involved in the decision process, evaluate the practice's needs and goals, involve the office staff, and compare costs before choosing a system. A set of guidelines for selecting an office computer is presented.

Computer Literacy↗
PubMed2005

Routine history as compared to audio computer-assisted self-interview for prenatal care history taking.

OBJECTIVE: To compare endorsement rates obtained with audio computer-assisted self-interview versus routine prenatal history. STUDY DESIGN: A crosssectional study compared items captured with the routine history to those captured with a computer interview (computer screen displaying and computer audio reading questions, with responses entered by touch screen). The subjects were women (n=174) presenting to a public hospital clinic for prenatal care. RESULTS: The prevalence of positive responses using the computer interview was significantly greater (p < 0.01) than with the routine history for induced abortion (16.8% versus 4.0%), lifetime smoking (12.8% versus 5.2%), intimate partner violence (10.0% versus 2.4%), ectopic pregnancy (5.2% versus 1.1%) and family history of mental retardation (6.7% versus 0.6%). Significant differences were not found for history of spontaneous abortion, hypertension, epilepsy, thyroid disease, smoking during pregnancy, gynecologic surgery, abnormal Pap test, neural tube defect or cystic fibrosis family history. However, in all cases, prevalence was equal or greater with the computer interview. CONCLUSION: Women were more likely to report sensitive and high-risk behavior, such as smoking history, intimate partner violence and elective abortion, with the computer interview. The computer interview displayed equal or increased patient reporting of positive responses and may therefore be an accurate method of obtaining an initial history.

Abortion, Induced↗
PubMed1999

Assessing and enhancing medical students' computer skills: a two-year experience.

In 1984, the Association of American Medical Colleges (AAMC) issued recommendations for the reform of medical education. One recommendation was that information sciences be incorporated into the medical curriculum. In fall 1996, a survey was conducted to learn more about computer use by medical students at the Rockford regional site of the University of Illinois at Chicago College of Medicine. The purpose of the survey was to gather information not only about computer skills, but also about overall comfort level in using computers and about expectations for enhancing computer skills while attending medical school. Over a two year period, 208 students representing four classes received this survey in their e-mail. Non-respondents received a follow-up print copy in their student mailboxes. Results, based on a 60% response rate, showed a majority of Rockford students entered medical school with good skills in using e-mail and word processing, but many lacked the skills necessary to search the medical literature or to use computer-assisted instructional programs. Overall, 80% of students expected to learn more about computers while attending medical school. Results contributed to an increased effort to integrate computer applications into the medical curriculum and to use computers as a means of communicating with students.

Computer Communication Networks↗
PubMed2005

Tablet computers in the veterinary curriculum.

Tablet computers offer a new method of information management in veterinary medical education. With the tablet computer, students can annotate class notes using electronic ink, search for keywords, and convert handwriting to text as needed. Additional electronic learning resources, such as medical dictionaries and electronic textbooks, can be readily available. Eleven first-year veterinary students purchased tablet computers and participated in an investigation of their working methods and perceptions of the tablet computer as an educational tool. Most students found the technology useful. The small size and portability of the tablet allowed easy transport and use in a variety of environments. Most students adapted to electronic notetaking by the second week of classes; negative experiences with the tablet centered on a failure to become comfortable with taking notes and navigating on the computer as opposed to writing and searching on paper. A few performance-related problems, including short battery life, were reported. Tablet software allowed conversion of faculty course notes from a variety of original formats, meaning that instructors could maintain their original methods of note preparation. Adopting a consistent naming convention for files helped students to locate the files on their computers, and smaller file sizes helped with computer performance. Collaboration between students was fostered by tablet use, which offers possibilities for future development of collaborative learning environments.

Attitude to Computers↗
PubMed2006

Computer-assisted learning and simulation systems in dentistry--a challenge to society.

INTRODUCTION: Computer technology is increasingly used in practical training at universities. However, in spite of their potential, computer-assisted learning (CAL) and computer-assisted simulation (CAS) systems still appear to be underutilized in dental education. MATERIALS AND METHODS: Advantages, challenges, problems, and solutions of computer-assisted learning and simulation in dentistry are discussed by means of MEDLINE, open Internet platform searches, and key results of a study among German dental schools. RESULTS: The advantages of computer-assisted learning are seen for example in self-paced and self-directed learning and increased motivation. It is useful for both objective theoretical and practical tests and for training students to handle complex cases. CAL can lead to more structured learning and can support training in evidence-based decision-making. The reasons for the still relatively rare implementation of CAL/CAS systems in dental education include an inability to finance, lack of studies of CAL/CAS, and too much effort required to integrate CAL/CAS systems into the curriculum. CONCLUSION: To overcome the reasons for the relative low degree of computer technology use, we should strive for multicenter research and development projects monitored by the appropriate national and international scientific societies, so that the potential of computer technology can be fully realized in graduate, postgraduate, and continuing dental education.

Computer Simulation↗
PubMed1990

Utility of computed tomography for surveillance of small abdominal aortic aneurysms. Preliminary report.

To assess the ability of computed tomography to predict the potential for expansion of small abdominal aortic aneurysms, we analyzed the computed tomographic scans of 30 patients who had two or more abdominal computed tomographic scans at least 6 months apart between 1979 and 1989. Clinical variables and 10 defined objective characteristics of computed tomography were evaluated. Twenty-five men and five women with abdominal aortic aneurysms ranging from 30 to 64 mm (mean, 45 mm) were followed up with serial computed tomographic scans for a mean (+/- SE) of 26 +/- 3 months. In 19 patients, enlargement of aneurysm diameter of 3 mm or more on serial computed tomographic scans was noted, whereas in 11, there was little or no expansion. Of the clinical variables studied, only serum cholesterol correlated with an increased risk of expansion. Thrombus area, measured by computed tomography, was 7.3 +/- 0.9 cm2 in enlarging aneurysms vs 4.3 +/- 0.9 cm2 in stable aneurysms. Based on these preliminary data, we conclude that computed tomography may provide valuable information about the likelihood of future expansion of small abdominal aortic aneurysms.

Adult↗
PubMed1994

Assessment of personality traits and psychiatric symptoms in workers in a computer manufacturing plant in Japan.

To investigate personality traits and psychiatric symptoms, we administered the Structured Clinical Interview for DSM-III-R Personality Questionnaire (SCID-II Screen), the Zung Self-Rating Depression Scale (SDS), and the 30-item version of the General Health Questionnaire (GHQ-30) to 781 male computer engineers and 214 male clerical workers in a computer manufacturing factory. Subjects, aged from 20 to 49 years, were divided into university and high school graduates. Among the university graduates, scores for schizotypal and avoidant personality traits were significantly higher in computer engineers than in clerical workers (the effect of age was controlled by analysis of covariance). No significant correlation between personality traits and years employed was found in the university-graduate computer engineers. In high school graduates, scores for borderline and dependent personality traits were significantly lower in computer engineers than in clerical workers (the effect of age was controlled by analysis of covariance). Because of the lack of significant association of personality traits and symptoms with duration of employment in the university-educated computer engineers, the greater prevalence of schizotypal and avoidant personality traits might be related to their process of self-selection of job rather than to computer manufacturing work. In summary, these data suggest that computer engineering work does not cause abnormal personality traits or psychiatric symptoms.

Adult↗
PubMed2000

Acute left colonic diverticulitis--compared performance of computed tomography and water-soluble contrast enema: prospective evaluation of 420 patients.

PURPOSE: The most valuable radiologic examination to be done initially when acute left colonic diverticulitis is suspected is still a matter of controversy. This study compares the performance between water-soluble contrast enema and computed tomography. METHODS: From 1986 to 1997, all patients admitted in our emergency center with clinically suspected left-colonic diverticulitis had a contrast enema and a computed tomography within 72 hours of their admission, unless clinical findings required immediate laparotomy. They were prospectively included in the study if one or both radiologic examinations showed signs of acute diverticulitis or diverticulitis was surgically removed and histologically proven or both. Diverticulitis was considered moderate when computed tomography showed localized thickening of the colonic wall (5 mm or more) and inflammation of pericolic fat and contrast enema showed segmental lumen narrowing and tethered mucosa; it was considered severe when abscess or extraluminal air or contrast or all three were observed on computed tomography and when one or both of the last two signs were seen on contrast enema. Of 542 patients, 420 who had both computed tomography and contrast enema entered the study. RESULTS: The performance of computed tomography was significantly superior to contrast enema in terms of sensitivity (98 vs. 92 percent; P = 0.01), which was calculated from patients who had their colon removed and whose diverticulitis was histologically proven, and in the evaluation of the severity of the inflammation (26 vs. 9 percent; P = 0.02). Moreover, of 69 patients who had an associated abscess seen on computed tomography, only 20 (29 percent) had indirect signs of this complication on contrast enema. CONCLUSIONS: In the diagnostic evaluation of acute left-colonic diverticulitis, computed tomography should be preferred to contrast enema as the initial radiologic examination because of its statistically significant superiority in sensitivity and for its significantly better performance in the detection of severe infection, especially when an abscess is associated with the disease.

Abscess↗
PubMed2003

An in silico central pattern generator: silicon oscillator, coupling, entrainment, and physical computation.

In biological systems, the task of computing a gait trajectory is shared between the biomechanical and nervous systems. We take the perspective that both of these seemingly different computations are examples of physical computation. Here we describe the progress that has been made toward building a minimal biped system that illustrates this idea. We embed a significant portion of the computation in physical devices, such as capacitors and transistors, to underline the potential power of emphasizing the understanding of physical computation. We describe results in the exploitation of physical computation by (1) using a passive knee to assist in dynamics computation, (2) using an oscillator to drive a monoped mechanism based on the passive knee, (3) using sensory entrainment to coordinate the mechanics with the neural oscillator, (4) coupling two such systems together mechanically at the hip and computationally via the resulting two oscillators to create a biped mechanism, and (5) demonstrating the resulting gait generation in the biped mechanism.

Bionics↗
PubMed1990

Computers in medical education: information and knowledge management, understanding, and learning.

Desktop computers have evolved to permit physicians in practice and/or training to access and manage information to enhance knowledge, understanding, and learning. There are compelling reasons why the personal computer is key to learning and important in medical education. Above all, the computer enhances and amplifies the learning process. Using the desktop computer effectively is relatively easy. We teach our students to research information in books and journals and hope that, as practicing physicians, they do it even more to be current and maintain their competency. Why not a desktop computer to access and manage information, analyze it, and present findings? Computer technology is available to do virtually all of these tasks. Some tools are critical for medical students. For some time, all medical students have needed a black bag and microscope. Now every medical student needs a computer. Ample courseware is available and expanding rapidly for basic sciences and clinical disciplines. The explosion in biomedical information will continue. Finding information is key to understanding and learning rather than depending solely on memory, recall, or library trips for information. The desktop computer will benefit students, faculty, and future physicians and other health professionals as life-long learners.

Artificial Intelligence↗