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PubMed1983

Computers and clinical arrhythmias.

Cardiac arrhythmias are ubiquitous in normal and abnormal hearts. These disorders may be life-threatening or benign, symptomatic or unrecognized. Arrhythmias may be the precursor of sudden death, a cause or effect of cardiac failure, a clinical reflection of acute or chronic disorders, or a manifestation of extracardiac conditions. Progress is being made toward unraveling the diagnostic and therapeutic problems involved in arrhythmogenesis. Many of the advances would not be possible, however, without the availability of computer technology. To preserve the proper balance and purposeful progression of computer usage, engineers and physicians have been exhorted not to work independently in this field. Both should learn some of the other's trade. The two disciplines need to come together to solve important problems with computers in cardiology. The intent of this article was to acquaint the practicing cardiologist with some of the extant and envisioned computer applications and some of the problems with both. We conclude that computer-based database management systems are necessary for sorting out the clinical factors of relevance for arrhythmogenesis, but computer database management systems are beset with problems that will require sophisticated solutions. The technology for detecting arrhythmias on routine electrocardiograms is quite good but human over-reading is still required, and the rationale for computer application in this setting is questionable. Systems for qualitative, continuous monitoring and review of extended time ECG recordings are adequate with proper noise rejection algorithms and editing capabilities. The systems are limited presently for clinical application to the recognition of ectopic rhythms and significant pauses. Attention should now be turned to the clinical goals for detection and quantification of arrhythmias. We should be asking the following questions: How quantitative do systems need to be? Are computers required for the detection of all arrhythmias? In all settings? Should we be focusing alternatively on those arrhythmias that are frequent and with clinical significance? The ultimate test of any technology is, after all, its use in advancing knowledge and patient care.

Arrhythmias, Cardiac↗

PubMed1984

Computers in medicine: patients' attitudes.

Data are presented from two surveys where a 26-item questionnaire was used to measure patients' attitudes to diagnostic computers and to medical computers in general. The first group of respondents were 229 patients who had been given outpatient appointments at a hospital general medical clinic specializing in gastrointestinal problems, where some had experienced a diagnostic computer in use. The second group of respondents were 416 patients attending a group general practice where there was no computer. Patients who had experience of the diagnostic computer or a personal computer had more favourable attitudes to computers in medicine as did younger people and males. The two samples of patients showed broadly similar attitudes, and a notable finding was that over half of each group believed that, with a computer around, the personal touch of the doctor would be lost.

Attitude↗

PubMed1981

Gastric adenocarcinoma: a comparison of the accuracy and economics of staging by computed tomography and surgery.

We studied a series of 22 patient with proven gastric adenocarcinoma who underwent upper gastrointestinal radiography, computed tomography, upper gastrointestinal endoscopy, and/or surgical exploration and resection. Based on the computed tomographic findings, gastric carcinoma was classified into one of four stages: stage 1, intraluminal masses without gastric wall thickening; stage 2, gastric wall thickening (> 1 cm) and exophytic masses; stage 3, gastric wall thickening and contiguous spread of tumor into adjacent organs such as the pancreas, spleen, liver, transverse mesocolon, or esophagus; and stage 4, gastric wall thickening with distant metastatic disease. The stage of gastric malignancy as determined by computed tomography was correlated with presenting symptoms, location of tumor, upper GI findings, endoscopy, and findings of surgical exploration. The cost and estimated initial saving realized by performing routine preoperative gastric computed tomographic examinations were analyzed. Our results indicated that computed tomographic staging of gastrointestinal malignancy correlated closely with surgical findings and compared with other modalities, local extension, regional adenopathy, and the size of the tumor mass were better evaluated by computed tomography. Computed tomographic staging of gastric tumors cost $7150 and resulted in an estimated initial savings of $35,000-$56,000. The results of this study indicated that computed tomography is an accurate, cost effective method of preoperatively staging gastric carcinoma, capable of providing staging information heretofore only available by surgical exploration.

Adenocarcinoma↗

PubMedDate not supplied

Differences between manual and computer-based methods for clinical learning assignments.

Two methods of assigning nursing students to clinical learning settings were compared for accuracy and speed. The first, a manually prepared method, was based on student preferences and experiential knowledge of nursing faculty. The second, a computer program designed for the project, used decision rules derived from ratings of student learning capabilities and ratings of the perceived demand for such capabilities by clinical settings. Ratings were assigned numerical values and were processed by the computer to obtain the best matches between students and settings. The same ratings were applied to the hand-prepared method after this assignment was completed. Comparison of the results showed that the best fit (least total numerical differences) between students and settings for the whole class was found by the computer, indicating that the computer method was superior. A completely randomized computer assignment that was run as an added source for comparison was much less effective than the assignment completed by hand, suggesting that human decision-making is an important factor in making clinical assignments. In terms of speed, 5.5 hours were used to prepare an assignment by hand and to make an adjustment; the computer completed the assigning task in less than 3 minutes. An alternate computing algorithm, used subsequently, completed the task in 3 seconds. The authors concluded that human judgment is necessary in making clinical assignments, but use of a tailored computer matching program can improve the quality of the decision making and can reduce the time and energy spent on this task.

Computer Systems↗

PubMed1994

Academic physicians' assessment of the effects of computers on health care.

We assessed the attitudes of academic physicians towards computers in health care at two academic medical centers that are in the early stages of clinical information-system deployment. We distributed a 4-page questionnaire to 470 subjects, and a total of 272 physicians (58%) responded. Our results show that respondents use computers frequently, primarily to perform academic-oriented tasks as opposed to clinical tasks. Overall, respondents viewed computers as being slightly beneficial to health care. They perceive self-education and access to up-to-date information as the most beneficial aspects of computers and are most concerned about privacy issues and the effect of computers on the doctor-patient relationship. Physicians with prior computer training and greater knowledge of informatics concepts had more favorable attitudes towards computers in health care. We suggest that negative attitudes towards computers can be addressed by careful system design as well as targeted educational activities.

Academic Medical Centers↗

PubMedDate not supplied

Adaptive computing for people with disabilities.

Adaptive computing is a relatively new area, and little has been written in the nursing literature on the topic. "Adaptive computing" refers to the professional services and the technology (both hardware and software) that make computing technology accessible for persons with disabilities. Nurses in many settings such as schools, industry, rehabilitation facilities, and the community, can use knowledge of adaptive computing as they counsel, advise, and advocate for people with disabilities. Nurses with an awareness and knowledge of adaptive computing will be better able to promote high-level wellness for individuals with disabilities, thus maximizing their potential for an active fulfilling life. People with different types of disabilities, including visual, mobility, hearing, learning, communication disorders and acquired brain injuries may benefit from computer adaptations. Disabled people encounter barriers to computing in six major areas: 1) the environment, 2) data entry, 3) information output, 4) technical documentation, 5) support, and 6) training. After a discussion of these barriers, the criteria for selecting appropriate adaptations and selected examples of adaptations are presented. Several cases studies illustrate the evaluation process and the development of adaptive computer solutions.

Computers↗

PubMed1993

A controlled evaluation of computer assisted training simulations in geriatric dentistry.

The increasing number of geriatric dental patients and the development of treatment plans that require consideration of complex psychosocial, socioeconomic, and medical/medication factors necessitates a change in the traditional teaching of treatment planning. A computer-assisted instructional program was developed to simulate the dentist-geriatric patient interaction and to train students in clinical decision making for the geriatric patient. This study compared the effects of this program with a more traditional approach based on readings from the geriatric dentistry literature. Twenty third-year dental students were matched on grade point average and randomly assigned to the computer or literature-based groups. They were pretested using a clinical analogue of a geriatric patient and then instructed to use either the computer or literature-based educational units. The students were then post-tested on a second clinical analogue. Students performed similarly at pretest. At post-test, both the computer and literature-based subjects were found to have acquired significantly greater evaluation points, to make fewer errors, and to design more involved treatment plans than at pretest. Comparison of computer and literature-based subjects' performance revealed no significant main or interaction effects regarding type of educational unit used. Consistent nonsignificant trends were noted with the computer-based subjects out-performing literature-based subjects on each outcome variable. In addition, the computer-based subjects had more positive feelings about the educational unit than the literature-based subjects at a statistically significant level. These findings suggest that the computer program is an effective alternative method for developing clinical decision skills in students treating geriatric patients.(ABSTRACT TRUNCATED AT 250 WORDS)

California↗

PubMed1996

A prospective study of helical computed tomography angiography versus angiography for the detection of renal artery stenoses in hypertensive patients.

OBJECTIVE: To compare helical computed tomography angiography with arterial digital subtraction angiography in the diagnosis of renal artery stenoses. METHODS: Fifty hypertensives (24 men; mean age 53 years) were prospectively studied with computed tomography (Somaton Plus S, Siemens) and digital angiography (double-blind evaluation). Computed tomography was performed both in the sequential (the length of the abdomen) and in the helical (6 cm around renal arteries) modes during injection of 120 cm3 contrast medium. RESULTS: Digital angiography visualized 16 significant (< 50% on quantitative angiography) stenoses (16/131 renal arteries, including 32 accessory), in 14 (28%) patients. On helical computed tomography, 16 stenoses were detected, in 49 patients (16/122 renal arteries, seven accessory arteries were not identified because they were located out side the scan area); two patients had false-positive helical computed tomography results. The computed tomography sensitivity, specificity, positive and negative predictive values were 87.5% (14/16), 98.2% (111/114), 87.5% and 98.2%, respectively. In the sequential mode, two cases of bilateral adrenal hyperplasia, two aortic aneurysms and one renal neoplasm were detected. None of these patients had renal artery stenosis. CONCLUSIONS: Helical computed tomography is a suitable new non-invasive diagnostic modality for the detection of renal artery stenosis or adrenal pathology. With continued development and evaluation computed tomography could prove useful as a screening tool or as a replacement for digital angiography in patients with possible secondary hypertension.

Adolescent↗

PubMed1997

[In vitro evaluation of computer-assisted pedicle screw system].

GOAL: The goal of this study is to evaluate influence on the accuracy of pedicle hole positions when a surgeon uses a computer assisted system. STUDY DESIGN: This comparative study was undertaken using dry thoraco-lumbar specimens in order to measure the position of drilled holes with and without computer assistance in the hands of an experienced surgeon as well as with a resident in training. METHODS: Pedicle holes were drilled from D1 to L5 in identical dry thoraco- lumbar specimens. For half of the specimens a computer assisted pedicle screw installation system was used. Holes having been drilled for all specimens, we then measured the maximum distance between the axis of the drilled holes and the pedicle cortices All distances less or equal to 2 mm were classified as safe while all bigger distances were classified as unsafe for pedicle screw installation. RESULTS: Nine specimens were drilled for a total of 306 holes, 170 of them with computer assistance. We have observed a 95% success rate with the computer assisted holes compared to a 62% success rate using conventional methods (p < 0.001). No difference was found between the results of an experienced surgeon and the results of a resident in training while using the computer assistance system. All holes drilled from D12 to L5 were found to be in optimal position, completely within the pedicles. CONCLUSION: These results suggest that this computer assisted pedicle screw installation system could improve the accuracy of pedicle screw placement and enhance the safety of the procedure. Moreover, the computer system could become a valuable teaching tool for the training spine surgeons.

Bone Screws↗

PubMedDate not supplied

Computer-assisted neurosurgery system: Wayne State University hardware and software configuration.

Computer-assisted neurosurgery uses the latest technological advancements in imaging, computers, mechanics, and electronics to improve the accuracy and reduce the invasiveness and risk of neurosurgical procedures. We describe the Wayne State University, Detroit, Michigan, computer-assisted neurosurgical system with the emphasis on software and discuss the theory guiding the development of this system and its application in real-time position tracking systems. Our system consists of the Neurological Surgery Planning System (NSPS) software which we developed at our medical center and three types of position tracking systems: the Zamorano-Dujovny (Z-D) are digitizer for frame-based procedures, an articulated arm, and an infrared-based digitizer for frameless procedures. The NSPS software is designed to offer neurosurgeons a safe and accurate method to approach intracranial lesions by preoperatively planning a surgical trajectory. Software consisting of the most advanced technologies in computer vision, computer imaging/graphics, and stereotactic numeric analysis forms the core of the system. Capabilities for correlating data from imaging studies to facilitate image reconstruction, image mapping, and three-dimensional (3D) visualization of target volumes enable the neurosurgeon to simulate surgical procedures into a preoperative protocol to be used during surgery, both to follow the preplanned trajectory and to track the position of surgical instruments in real-time on the computer monitor. The tracking systems position and orient the surgical instruments relative to the patient's head. With these devices, the display of the surgical instruments together with the virtual images create an excellent intraoperative tool.

Algorithms↗

PubMed2005

Reverse-engineering gene-regulatory networks using evolutionary algorithms and grid computing.

OBJECTIVE: Living organisms regulate the expression of genes using complex interactions of transcription factors, messenger RNA and active protein products. Due to their complexity, gene-regulatory networks are not fully understood.However, by building computational models it is possible to gain insight into their function and operation. METHODS: Evolutionary algorithms are used to create computational models of gene-regulatory networks based on observed microarray data. These algorithms can be computationally intensive. They will be implemented within an existing grid computing infrastructure, that has been developed for data mining purposes, and which is able to deliver the required compute power. RESULTS: We discuss how models can built achieved using distributed and grid computing technology. In particular we investigate how Condor and JavaSpaces technology is suited to the requirements of our modeling approach. CONCLUSIONS: Determining network models of gene-regulatory networks using evolutionary algorithms not only requires considerable computational power, but also a modeling formalism that can explain the underlying dynamics.

Algorithms↗

PubMed1992

Empirical evidence shows that measuring users' opinions is not a satisfactory way of evaluating computer-assisted learning in nurse education.

Users' opinions have been one of the cornerstones of the evaluation of both CAL, in general, and CAL packages, in particular, in nurse education. This paper reports on two experiments that reliably show student nurses' opinions of their current computer-use are formed more by the change from a previously-used computing facility rather than the actual features that the current one possesses. The use of such opinions as a valid evaluation measure within nursing CAL is, consequently, weakened. The evaluation context in which these experiments are conducted derives from the highly-researched multidisciplinary area of Human-Computer Interaction (HCI), and the experiments are introduced and discussed with respect to the HCI concepts of computer-use and usability which examine the interactions taking place at the human-computer interface. Graphical hypertext and the doctrine of functionality are also introduced and discussed, for these aspects have considerable implications for computer-use and the process of planning and choosing computer-use facilities within nurse education.

Attitude of Health Personnel↗

PubMed1994

Prostate cancer: comparison of retrograde urethrography and computed tomography in radiotherapy planning.

PURPOSE: To prospectively compare the role of retrograde urethrography and high-quality computed tomography during the treatment planning of patients with prostate cancer. METHODS AND MATERIALS: Forty consecutive men with localized prostate cancer underwent planning computed tomography prior to stimulation. At the time of simulation we performed retrograde urethrography and compared the location of the inferior border of the urogenital diaphragm to the location of the ischial tuberosities and the prostate and base of the penis as seen on the computed tomography scan. RESULTS: Interobserver identification of the prostatic apex varied in 70% of the cases. Perhaps due to this variability, attempts to place the inferior border of the treatment field in relation to the prostatic apex resulted in an inadequate margin (< 1 cm) beneath the urogenital diaphragm in 5%. In contrast, placing the inferior border at the ischial tuberosities or the base of the penis as seen on computed tomography insured an adequate margin for all patients. The distance from the urogenital diaphragm to the ischial tuberosities and, thus, the potential margin beneath the urogenital diaphragm was > 2 cm in 77%, while the distance from the urogenital diaphragm to the base of the penis was > or = 2 cm in only 43%. CONCLUSION: This demonstrates the difficulty in reliably identifying the prostate on computed tomography. Nevertheless, by identifying the base of the penis, planning computed tomography provides adequate information to cover the target volume, and results in minimal overtreatment of normal structures. Urethrograms are not necessary if the computed tomography is properly used or if the ischial tuberosities are used as a standard inferior border, but they can reduce the length of urethra in the treatment volume which could potentially reduce complications.

Aged↗

PubMed2006

Survey of handheld computing among medical students.

The purpose of this study was to identify trends in the utilization and acceptance of handheld computers (personal digital assistants) among medical students during preclinical and clinical training. We surveyed 366 medical students and collected information on computer expertise, current handheld computer use, predicted future use, and user acceptance. Handheld computers were primarily used for personal applications by students during their preclinical training and as drug references and clinical calculators during their clinical training. In the future, all participants predicted they would use handheld computers at significantly higher rates and on a broader range of medical applications. The adoption of handheld computing was independent of user satisfaction. Those with more clinical experience were less satisfied with handheld computers, suggesting that the expectations of the more experienced users were not met. The lack of institutional support was seen as a key limitation.

Attitude to Computers↗

PubMed2005

Computational simulations of the total cavo-pulmonary connection: insights in optimizing numerical solutions.

The Fontan procedure is a palliative surgical technique that is used to treat patients with congenital heart defects that include complex lesions such as those with a hypoplastic ventricle. In vitro, in vivo, and computational models of a set of modifications to the Fontan procedure, called the total cavopulmonary connection (TCPC), have been developed. Using these modeling methods, attempts have been made at finding the most energy efficient TCPC circuit. Computational modeling has distinct advantages to other modeling methods. However, discrepancies have been found in validation studies of TCPC computational models. There is little in the literature available to help explain and correct for such discrepancies. Differences in computational results can occur when choosing between steady flow versus transient flow numerical solvers. In this study transient flow solver results were shown to be more consistent with results from previous TCPC in vitro experiments. Using a transient flow solver we found complex fluctuating flow patterns can exist with steady inflow boundary conditions in computational models of the TCPC. To date such findings have not been reported in the literature. Furthermore, our computational modeling results suggest fluctuating flow patterns as well as the magnitudes of these secondary flow structures diminish if the TCPC offset between vena cavae is increased or if flanged connections are added. An association was found between these modifications and improvements in TCPC circuit flow efficiencies. In summary, development of accurate computational simulations in the validation process is critical to efforts in finding the most efficient TCPC circuits, efforts aimed at potentially improving the long term outcome for Fontan patients.

Blood Flow Velocity↗

PubMedDate not supplied

Rural women with chronic illness: computer use and skill acquisition.

Chronically ill rural women must manage complex illness without easy access to health care resources including support and health information. The Women to Women project is a technology-based program with an overarching aim to assist rural women in the day-to-day management of their illnesses. An important aspect of the Women to Women program is teaching the women how to use the Internet to meet their support and informational needs. The purposes of this article are to examine changes in 1) the level of computer skills, 2) degree of comfort in using the computer, and 3) knowledge of Internet functions for the participants in the Women to Women computer-based intervention. Results of the initial analysis of data from 63 women (intervention group n = 29, control group n = 34) indicate that women participating in the intervention reported greater computer skills and computer comfort and greater knowledge of specific aspects of Internet use than women in the control group. These findings were further strengthened considering that intervention and control group differentials were sustained 8 months after the end of the women's participation in the computer intervention. With the attainment of computer and Internet skills, it is expected that these rural women will have a sustained ability to access quality Internet information that will allow them to better manage and adapt to their chronic illnesses.

Adult↗

PubMed1997

Benchmark test cases for evaluation of computer-based methods for detection of setup errors: realistic digitally reconstructed electronic portal images with known setup errors.

PURPOSE: The purpose of this investigation was to develop methods and software for computing realistic digitally reconstructed electronic portal images with known setup errors for use as benchmark test cases for evaluation and intercomparison of computer-based methods for image matching and detecting setup errors in electronic portal images. METHODS AND MATERIALS: An existing software tool for computing digitally reconstructed radiographs was modified to compute simulated megavoltage images. An interface was added to allow the user to specify which setup parameter(s) will contain computer-induced random and systematic errors in a reference beam created during virtual simulation. Other software features include options for adding random and structured noise, Gaussian blurring to simulate geometric unsharpness, histogram matching with a "typical" electronic portal image, specifying individual preferences for the appearance of the "gold standard" image, and specifying the number of images generated. The visible male computed tomography data set from the National Library of Medicine was used as the planning image. RESULTS: Digitally reconstructed electronic portal images with known setup errors have been generated and used to evaluate our methods for automatic image matching and error detection. Any number of different sets of test cases can be generated to investigate setup errors involving selected setup parameters and anatomic volumes. This approach has proved to be invaluable for determination of error detection sensitivity under ideal (rigid body) conditions and for guiding further development of image matching and error detection methods. Example images have been successfully exported for similar use at other sites. CONCLUSIONS: Because absolute truth is known, digitally reconstructed electronic portal images with known setup errors are well suited for evaluation of computer-aided image matching and error detection methods. High-quality planning images, such as the visible human CT scans from the National Library of Medicine, are essential for producing realistic images. Sets of test cases with systematic and random errors in selected setup parameters and anatomic volumes are suitable for use as standard benchmarks by the radiotherapy community. In addition to serving as an aid to research and development, benchmark images may also be useful for evaluation of commercial systems and as part of a quality assurance program for clinical systems. Test cases and software are available upon request.

Computer Simulation↗

PubMed2002

Global computing for bioinformatics.

Global computing, the collaboration of idle PCs via the Internet in a SETI@home style, emerges as a new way of massive parallel multiprocessing with potentially enormous CPU power. Its relations to the broader, fast-moving field of Grid computing are discussed without attempting a review of the latter. This review (i) includes a short table of milestones in global computing history, (ii) lists opportunities global computing offers for bioinformatics, (iii) describes the structure of problems well suited for such an approach, (iv) analyses the anatomy of successful projects and (v) points to existing software frameworks. Finally, an evaluation of the various costs shows that global computing indeed has merit, if the problem to be solved is already coded appropriately and a suitable global computing framework can be found. Then, either significant amounts of computing power can be recruited from the general public, or--if employed in an enterprise-wide Intranet for security reasons--idle desktop PCs can substitute for an expensive dedicated cluster.

Computational Biology↗