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Defining clinical workstation.
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Computer Systems↗
Incorporating data from dissimilar programs.
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Electronic Data Processing↗
A comparison of two methods of teaching. Computer managed instruction and keypad questions versus traditional classroom lecture.
Computers increasingly are being integrated into nursing education. One method of integration is through computer managed instruction (CMI). Recently, technology has become available that allows the integration of keypad questions into CMI. This brings a new type of interactivity between students and teachers into the classroom. The purpose of this study was to evaluate differences in achievement between a control group taught by traditional classroom lecture (TCL) and an experimental group taught using CMI and keypad questions. Both control and experimental groups consisted of convenience samples of junior nursing students in a baccalaureate program taking a medical/surgical nursing course. Achievement was measured by three instructor-developed multiple choice examinations. Findings demonstrated that although the experimental group demonstrated increasingly higher test scores as the semester progressed, no statistical difference was found in achievement between the two groups. One reason for this may be phenomenon of vampire video. Initially, the method of presentation overshadowed the content. As students became desensitized to the method, they were able to focus and absorb more content. This study suggests that CMI and keypads are a viable teaching option for nursing education. It is equal to TCL in student achievement and provides a new level of interaction in the classroom setting.
Achievement↗
Computerized support for case management ISAACC.
As the discipline of nursing strives to remain the logical orchestrator of case management, the ideal tool to support this effort would be based on a practice-oriented nursing theory. One such theory, Self-Care Deficit Nursing Theory, has formed a base for a computerized system that has the potential to support case management. This article briefly describes the Professional Care System and the component of the system that can support case management: Intelligent System Access to Automated Clinical Charting (ISAACC) and plans for further expansion of the system.
Case Management↗
The development of automated client responses for computerized clinical simulation testing.
Computerized Clinical simulation Testing (CST) is under research and development by the National Council of State Boards of Nursing for potential use as a component of the National Council Licensure Examination for Registered Nurses. This interactive software permits the realistic assessment and management of client needs through free-text entry of requests for nursing activities. Implementation of each nursing activity elicits a realistic client response. A major component of the system is a default client response database that incorporates responses for 38 different client condition categories as well as rules for their automation. This article describes and illustrates the characteristics and complexity of this database that is designed to assist in the portrayal of realistic client situations.
Artificial Intelligence↗
[The SINTESI Project: software in cardiovascular prevention].
Coronary heart disease is the most important cause of mortality in adults. New approaches may reduce the cardiovascular risk in population. "SINTESI" is an original data base designed in collaboration with the Italian Group for the Study of Metabolism Disease and Atherosclerosis to improve the evaluation of the major risk factors in the population and to create a data bank for medical research. It runs in Windows. The software includes the following electronics archives: Demographics; History; Follow-up; ECG; Laboratory; Doppler-echocardiography; Stress test-ECT; Ambulatory blood pressure monitoring; Holter-ECG; Nuclear imaging; Vascular echo-Doppler; Hemodynamics; Radiology. We named the most important file "Main Working Area" (MWA). This displays all the most important information on the clinical status of the patients and represents the "console" for using the software. In fact, in MWA "buttons" are displayed to enter all the electronic archives. The software displays graphics and the flow-chart of clinical history. We implemented "routines" for automatic evaluation of several variables. We also simplify the statistical use of the data implementing functions for "query" that permit the management of data bank. The use of this software may facilitate the correct evaluation and stratification of the cardiovascular risk. In conclusion, "Progetto SINTESI" is an easy, synthetic organization of patient's clinical data and a complete data bank. It is our opinion that the use of this software may promote a standard way of collecting a large number of data to improve the stratification of cardiovascular risk.
Adult↗
Collaboration using Internet for the development of case-based teaching files: report of the Computer and Instrumentation Council Internet Focus Group.
UNLABELLED: The Internet and particularly the World-Wide-Web is becoming a useful tool for the nuclear medicine community. METHODS: The Computer and Instrumentation Council of the Society of Nuclear Medicine convened an Internet Focus group to discuss collaboration using the Internet. The prototype application considered was development of case-based teaching files using the World-Wide-Web. Teaching file cases (clinical history, images, description of findings and discussion) on World-Wide-Web servers at different institutions are integrated using the Internet. The user can navigate from case to case using point-and-click hypertext linking. RESULTS: The initial experience with collaboration has been encouraging. An etiquette to help foster collaboration has been proposed. Development of quality control mechanisms and introduction of peer review were identified as issues needing further work. CONCLUSION: The World-Wide-Web offers great potential for new forms of collaboration. There is, however, a need to learn how to make best use of this new resource.
Computer Communication Networks↗
The informatics superhighway: prototyping on the World Wide Web.
We have experimented with developing a prototype Surgeon's Workstation which makes use of the World Wide Web client-server architecture. Although originally intended merely as a means for obtaining user feedback for use in designing a "real" system, the application has been adopted for use by our Department of Surgery. As they begin to use the application, they have suggested changes and we have responded. This paper illustrates some of the advantages we have found for prototyping with Web-based applications, including security aspects.
Computer Communication Networks↗
WHAM!: a forms constructor for medical record access via the World Wide Web.
WWW-EMRS is an architecture that provides a set of abstractions of electronic medical record systems (EMRS). This architecture has enabled us to implement interfaces to heterogeneous EMRS via the World-Wide Web that provide consistent visual presentations and functionality. We describe WHAM!, a program that allows rapid generation of customized interfaces to WWW-EMRS that therefore deliver the customized functions across multiple EMRS.
Computer Communication Networks↗
The Single Logon Application: an enabler for access to disparate systems in a patient-focused care environment.
The presence of separate, independent systems for patient results is a common problem in many institutions. The Single Logon Application (SLA) was developed to mitigate the problems presented by these disparate systems, and its use was a key component in a Patient-Focused Care (PFC) implementation.
Computer Systems↗
CareBase: a reference base for nursing.
Due to the lack of generally accepted nursing classifications and standards in Germany the introduction of nursing information systems for planning and documentation of care is a very time consuming process since the classifications and standards must be defined locally to adjust the systems. At the University Hospital Freiburg a nursing reference system was developed to collect this knowledge, make it available for easy reference and as a source usable for the initialisation of nursing information systems to be installed in the future.
Humans↗
Representation of clinical practice guidelines through an interactive World-Wide-Web interface.
The widespread utility of clinical practice guidelines is greatly dependent on the ease with which they can be accessed, used, and applied. Because it supports hyperlinking and is widely accessible, the World-Wide Web is a medium that is well suited for browsing through guidelines. We have developed a process for implementing algorithmic guidelines into a graphical format that allows the user to browse these guidelines in an interactive fashion. The guidelines we used were already in or could be transformed to an algorithmic format that lends itself well to analysis with decision table techniques, which in turn permits a fairly straightforward conversion into a graphical representation. The results of this process allow a user to browse a particular guideline algorithm and to visualize the traversed parts of the algorithm by flowcharts. Our first experiences with this method of representing a few sample clinical practice guidelines have been encouraging, and we hope to extend this method to other guidelines.
Algorithms↗
A web-based architecture for a medical vocabulary server.
For health care providers to share computing resources and medical application programs across different sites, those applications must share a common medical vocabulary. To construct a common vocabulary, researchers must have an architecture that supports collaborative, networked development. In this paper, we present a web-based server architecture for the collaborative development of a medical vocabulary: a system that provides network services in support of medical applications that need a common, controlled medical terminology. The server supports vocabulary browsing and editing and can respond to direct programmatic queries about vocabulary terms. We have tested the programmatic query-response capability of the vocabulary server with a medical application that determines when patients who have HIV infection may be eligible for certain clinical trials. Our emphasis in this paper is not on the content of the vocabulary, but rather on the communication protocol and the tools that enable collaborative improvement of the vocabulary by any network-connected user.
Computer Communication Networks↗
A rule-based decision support application for laboratory investigations management.
The appropriate management of clinical laboratory requests in specialised clinical units often requires the adherence to pre-defined protocols. We evaluated the impact of a rule-based expert system for clinical laboratory investigations management in a pediatric liver transplantation unit of our hospital. After one year, we observed an overall reduction in laboratory resources consumption for transplanted patients (-27%) and a decrease in the percentage of "STAT" requested tests (-44%). The percentage of tests ordered in agreement with the protocols for those patients increased from 33% before the introduction of the expert system to 45% when the system was used. The system was perceived by the clinicians as increasing the overall benefits in use of clinical resources, improving the laboratory data management, and saving time for the execution of laboratory ancillary tasks.
Clinical Laboratory Information Systems↗
IMPACT: an object-oriented graphical environment for construction of multimedia patient interviewing software.
This paper describes our software for rapid construction of multimedia computer interviews. The program, which we call IMPACT, was designed to measure preferences for health outcomes using the standard gamble and other decision analytic techniques. IMPACT is also a multimedia shell program that allows researchers to interactively construct patient interviewing instruments without programming or scripting. It supports the integration of text, graphics, synthesized speech, digital sound and QuickTime movies into interviewing instruments through a point-and-click interface. IMPACT also supports branching logic and randomizing the presentation order of materials within an instrument. This allows customization of the presentation based on patient responses and facilitates experimental designs. Validation studies show that preference assessments performed using IMPACT have high test-retest reliability (r = 0.83, n = 96). Post-test surveys (n = 52) show that most subjects understand valuation methods (86%) and believe that the explanations provided were clear (96%) and that methods were reasonable (80%). The majority of subjects thought the preference assessment methods were not difficult to use (53%) and would have been comfortable using such methods for medical decisions (53%).
Computer Graphics↗
Querying temporal clinical databases with different time granularities: the GCH-OSQL language.
There is a need for managing temporal clinical information given at different levels of granularity. Different time granularities are also needed in querying clinical databases. In this paper, we describe GCH-OSQL (Granular Clinical History--Object Structured Query Language), an object-oriented temporally-oriented extension of SQL. GCH-OSQL is based on an object-oriented temporal data model. It allows storage of clinical information at different and mixed granularities. GCH-OSQL deals with the valid time of clinical information. GCH-OSQL offers also a graphical user-interface. It guides different end users, from expert to naive, to formulate expressive and correct queries.
Computer Graphics↗
A multi-lingual architecture for building a normalised conceptual representation from medical language.
The overall goal of MENELAS is to provide better access to the information contained in natural language patient discharge summaries (PDSs), through the design and implementation of a prototype able to analyse medical texts. The approach taken by MENELAS is based on the following key principles: (i) to maximise the usefulness of natural language analysis and the usability of its results, the output of natural language analysis must be a normalised conceptual representation of medical information; and (ii) to maximise the reuse of resources, language analysis should be domain-independent and conceptual representation should be language-independent. This paper discusses the results obtained and the issues raised when implementing these principles during the project.
Artificial Intelligence↗