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PubMed1985

Clinical computing in a teaching hospital.

This report describes a hospital-wide clinical computing system that permits physicians, nurses, medical students, and other health workers to retrieve data from the clinical laboratories; to look up reports from the departments of radiology and pathology; to look up demographic data and outpatient visits; to look up prescriptions filled in the outpatient pharmacy; to perform bibliographic retrieval of the MEDLINE data base; to read, write, retract, edit, and forward electronic mail; and to request delivery of a patient's chart. During a one-week study period, from 300 video display terminals located throughout the hospital, 818 patient care providers used a common registry of 539,000 patients to look up clinical and laboratory data 16,768 times; 477 other hospital workers used the patient registry 46,579 times. In a separate study of 586 health care providers, 470 (80 per cent) indicated that they used computer terminals "most of the time" to look up laboratory results; in contrast, 48 (8 per cent) preferred printed reports. Of 545 hospital workers, 440 (81 per cent) indicated that the computer terminals definitely or probably made their work more accurate, and 452 (83 per cent) indicated that terminals enabled them to work faster. The large amount of use by clinicians and their judgment that the computer has been so helpful to them suggests that a reliable, comprehensive, and easy-to-use computer system can contribute substantially to the quality of patient care.

Boston↗
PubMed1991

Computerisation of primary care in Wales.

OBJECTIVE: To obtain information about the computerisation of general practice in Wales, and to enable more effective planning of educational provision for doctors and other primary health care workers. DESIGN: Postal questionnaire sent to all general practices in Wales. SUBJECTS: 553 general practices, of which 401 (73% replied). RESULTS: The level of computerisation varied from 11 (85%) of practices in Powys Family Health Services Authority to 22 (40%) in Mid Glamorgan. Less than half of practices had a computer in only two authorities. The commonest uses of the computer were for patient registration (208 practices), repeat prescribing (180), call and recall of patients (165), and partial clinical records (122). The main suppliers were VAMP (78 practices), AAH Meditel (46), and AMC (23). 102 of 226 practices with a computer had a terminal on each doctor's desk. Just 33 practices had full patient notes on computer and 51 had modems for electronic communication. CONCLUSION: Mechanisms to encourage greater and more sophisticated use of computers and information technology need to be explored.

Ambulatory Care Information Systems↗
PubMed1999

Eye care when using video display terminals.

OBJECTIVE: To examine the scientific data in the literature regarding eye problems and possible damage during the use of computer video display terminals. DATA SOURCES: Medline and non-Medline literature search and personal experience. STUDY SELECTION: Studies that provided evidence-based information about eye damage and eye care during the use of video display terminals were selected. DATA EXTRACTION: Data were extracted independently by multiple observers. DATA SYNTHESIS: Most studies have shown that the levels of ionizing and non-ionizing radiation that are emitted by video display terminals are not harmful to the human eye. Eye complaints associated with the use of video display terminals include the McCollough effect, accommodative spasm, 'dry eyes', and eye strain. Ergonomic considerations and good visual hygiene can help alleviate symptoms. CONCLUSION: There is currently no convincing evidence that shows that using video display terminals is harmful to the eye.

Journal Article↗
PubMed1982

Interactive computer program for self-distributed medical questionnaire in a population health screening.

The questionnaire is an important element of a medical screening investigation, just as important as the biometrical screening tests. There are several difficulties in realizing interactive computer programs for such tasks. In the present report, we describe the design, operation and results of an interactive computer program for self-distributed medical questionnaire in which the screening subjects are informed and instructed on the terminal routines, and answer, check, confirm and record the questions direct in the computer terminals by means of simple keyboard functions. This program was possible to construct as an integrated component of the interactive computer system monitoring our multiphasic health screening in a standard minicomputer environment.

Computers↗
PubMed1991

A divided attention analysis of the effects of methylphenidate on the arithmetic performance of children with attention-deficit hyperactivity disorder.

Thirteen boys with Attention-Deficit Hyperactivity Disorder (ADHD) completed 80 arithmetic problems presented on a computer screen by typing a two digit answer. On half the trials, a foot press was required to terminate a computer-generated tone presented 2 seconds before, 1 second before, 1 second after, and 2 seconds after arithmetic problem presentation. Compared to placebo, methylphenidate resulted in significantly faster reaction times (RTs) to tone probes and faster answers to arithmetic problems when the two tasks did not overlap in time, but not when simultaneous processing was required when the probe was presented 2 seconds after arithmetic problems. When dual processing taxed cognitive capacity, methylphenidate still improved accuracy on the primary arithmetic task relative to placebo, but at the expense of speed of performance on the secondary RT task. When ADHD children fail to allocate available resources to a primary cognitive task, treatment with methylphenidate may result in reallocation of existing cognitive capacity from a secondary task to the primary task.

Attention↗
PubMedDate not supplied

Bedside terminals and quality of nursing documentation.

In this article, the authors report on part one of a three-part investigation studying the impact of bedside terminals at New York University Medical Center, New York, NY. Using a before-after parallel control-group design, the quality of computerized nursing documentation was studied before and after adding computers to patient rooms. The quality of documentation was defined by timeliness and completeness of data. The study hypothesis, which predicted a positive relationship between the presence of bedside terminals and the quality of nursing documentation, was not supported. Study results showed a minimal use of the computer terminals located in patient rooms. A surprising result was the use of terminals located in rooms other than that of the patient for which documentation was made.

Computer Terminals↗
PubMed1980

GENFILES: a computerized medical genetics information network. I. An overview.

GENFILES is a comprehensive computer information network to serve research, service, and administrative needs in medical genetics. Four major databases contain detailed information generated by the cytogenetics laboratory, the prenatal diagnosis program, the diagnostic and genetic counseling clinics, and the human cell culture facility. Unique aspects are the use of RAMIS, a commercial database management system, and of microprocessor computers as "intelligent" terminals with significant data-handling capabilities. All databases are no-line in a directly accessed large timesharing computer. The system, which has been designed, controlled and maintained by regular genetics staff, is an easy to use, moderate-cost tool well suited for use as a regional clinical genetics information system.

Computers↗
PubMed2002

Computer-assisted morphometric analysis of intrinsic axon terminals in the supragranular layers of cat striate cortex.

Qualitative and quantitative analyses of terminal arborizations of biocytin-labeled axon terminals were carried out in the cat primary visual cortex (V1). Extracellular iontophoretic injections of 5% biocytin were made into V1 of five adult cats. The animals were perfused 24-48 h after the injections. Labeled-axon fragments were considered to comprise two presumptive groups, according to the qualitative features, thickness, bouton features and appearance of terminal arbors. Forty axon fragments (20 for each presumptive group) were digitized using a microscope with motorized stage and a z-encoder, attached to a microcomputer. The densities of boutons, branching points and axon segments per mm of axon as well as axon segment length were used for comparison of the two groups. The two qualitative groups were confirmed to contain two axon types (I and II), according to cluster analysis of characteristics of the 40 axons in our sample. Forward stepwise discriminant analysis retained two variables as predictors of group membership: axonal length and bouton density. Parametric and non-parametric tests were employed for statistical comparisons (significance at P < 0.01). Type II axon fragments showed the greatest densities of boutons, axonal segments and branching points and the smallest values of length of segments ( P < 0.01). Both the qualitative and quantitative differences found for both types of axons suggest that they belong to different functional classes of neurons, namely spiny (type I) and smooth neurons (type II). Computer-assisted morphometric analysis of individual axon fragments seems to be a suitable approach with which different axon types can be objectively distinguished from each other.

Animals↗
PubMed1990

[Effect of the curriculum including the computer use on work capacity and health status of older schoolchildren].

Formation of computer skills + of pupils is one of the most acute tasks for school today. The relationship between the functional state of the central nervous system, visual analyser and efficiency of pupils with age, have been established. Motivation for work with the computer and quality of the computer video-terminal has been established. Questionnaires given to about 500 pupils have shown that the majority of pupils show an interest to working with computers: 82.5% of 13-14-year old and 70% of 16-17-year old adolescents. Efficiency of pupils becomes more stable with age. The highest number of astheno-neurotic tic symptoms and fatigue complaints are registered in pupils with a low interest to working with computers, as well as in pupils dealing with computers of low quality (of the type Personal Computer 0010). Duration of pupils' work with computers should be no longer than 30 minutes.

Adolescent↗
PubMed1991

A 24-hour ordering system for clinical examinations.

We have developed a 24-hour ordering system for clinical examinations, making use of the features of multi-function workstation (IBM5550) which performs two functions both in an on-line terminal and in a personal computer. It is used as an on-line terminal for the host computer (IBM4381) in day time. At night or on holiday, it is used as a stand-alone type personal computer to order clinical examinations. For this purpose, basic information of the inpatients (patient number, name, sex, date of birth, clinic, ward) are transferred from the host computer to the disket in the workstation in the evening when host computer finished on-line service. A physician can input the patient number followed by examination items using the touch panel according to the dialogue type guides written in Chinese character. Then, specimen label, list of ordered tests and an order form are printed out instantly. The date (patient number, examination items, identification number of the specimen, etc.) stored in the disket in the workstation at night are transferred from workstation to the host computer next morning. The host computer merges the information ordered in day time and at night and supplies working documents for examination (worksheets, master log, etc.) to technicians. Thus physicians can order examinations all day long using workstation, which make it possible to spare the time.

Clinical Laboratory Information Systems↗
PubMed1998

Influence of VDT monitor positions on discomfort and performance of users with or without bifocal lenses.

The difficulty of video display terminal users with bifocal lenses through a traditional workstation increases the complaints and risks for upper extremity cumulative trauma disorders. Furthermore, the regular and no lens users also have problems with traditionally designed workstations over prolonged periods of video display terminal use. A study was conducted on 14 subjects to investigate the effect of computer monitor location for video display terminal users with or without bifocals on subjective assessment and performance. The two monitor locations were 15 degrees and 40 degrees below horizontal eye level. The experimental task consisted of reading words from computer screens and typing them from the reverse side to the next column. Each experimental session lasted one hour. Males with bifocal lenses had less discomfort in the neck, shoulders, forearms, and wrists, less tiredness and eyestrain and higher performance with a 40 degrees angle monitor than with a 15 degrees angle monitor. A similar conclusion has been reached for females. Users with bifocal lenses had significantly higher neck discomfort and lower performance than nonbifocal users. The 40 degrees angle monitor caused less neck discomfort than the 15 degrees angle monitor did. Overall, females had less physical discomfort, less tiredness, and higher performance than males.

Adult↗
PubMed1990

A computerized respiratory sinus arrhythmia program for the non-invasive assessment of parasympathetic activity.

The availability of sophisticated signal analysis methods based on the use of micro-computers allows an accurate non-invasive assessment of parasympathetic activity, through the measurement of the respiratory sinus arrhythmia. The program described herein is in Quickbasic and consists of 5 programs. At termination of the computer analysis the results are printed which include the average heart rate for inspiration and expiration, the averaged standard deviation of the R-R intervals for inspiration and expiration, and the R-R interval in milliseconds averaged for all inspiratory and expiratory cycles. Significant correlations were obtained when comparing the analyses of the computerized program with a manual method.

Analog-Digital Conversion↗
PubMed1991

Computer modeling of synapsin I binding to synaptic vesicles and F-actin: implications for regulation of neurotransmitter release.

Synapsin I is a neuron-specific phosphoprotein that binds to small synaptic vesicles and actin filaments in a phosphorylation-dependent fashion. It has been hypothesized that dephosphorylated synapsin I inhibits neurotransmitter release either by forming a cage around synaptic vesicles (cage model) or by anchoring them to the F-actin cytoskeleton of the nerve terminal (crosslinking model). Computer modeling was performed with the aim of testing the impact of phosphorylation on the molecular interactions of synapsin I within the nerve terminal. The results of the simulation experiments demonstrate that in the crosslinking model the phosphorylation of synapsin I causes a severalfold increase in the number of vesicles released from the cytoskeleton and that in the cage model the phosphorylation induces a 2-fold increase in the number of vesicles bearing one or more unsaturated synapsin I binding sites. These data are compatible with the view that the function of synapsin I in the short-term regulation of neurotransmitter release is to induce a phosphorylation-dependent transition of synaptic vesicles from a "reserve pool" to a readily "releasable pool" of vesicles.

Actins↗
PubMed1993

[Computerized database system for pure tone audiometry].

The management and storage of pure tone audiometry data creates a major problem for otolaryngological clinics. We have devised a new computerized database system to overcome this problem. The hardware involved includes multiple audiometers and computers interfaced with a glassfiber local area network (Pi-Net). The software used is database 3 plus, a popular database language and utility software package. Programs were written for data entry, data transfer, reference, entry of patient ID, and evaluation of tympanoplasty. The following benefits of the system are noted. 1) Data entry is possible at every terminal (audiometer and computer). 2) Storage capacity is sufficient for more than 10 years of operation. 3) All data can be retrieved rapidly at any terminal. Evaluations of pre- and post-tympanoplasty hearing loss are facilitated by this system. This system is very effective for follow up of hearing disorders.

Audiometry, Pure-Tone↗
PubMed2003

Accommodative response to PRIO Computer Vision Tester versus printed text.

BACKGROUND: Video display terminals (VDTs) have Gaussian display characteristics. Research suggests that patients accommodate differently to Gaussian images. In the present study, we asked if the accommodative response to the PRIO Computer Vision Tester (a Gaussian image) is different than the accommodative response to a Monocular Estimation Method (MEM) printed text target. METHOD: A normally sighted prepresbyopic group of subjects (N = 60) was recruited from the student body of Nova Southeastern University. Low neutral retinoscopy was performed on each subject at a distance of 50 cm. using both the PRIO vision tester and an MEM target. RESULTS: The PRIO vision tester and the printed text provided essentially the same measures of accommodative response. In addition, the luminance of the PRIO dropped by nearly 40% over the course of 1 hour of intermittent use. CONCLUSION: The PRIO vision tester and traditional nearpoint retinoscopy provided essentially the same measures of accommodative response in prepresbyopic subjects. Further studies should be considered to evaluate whether the change in luminance of the PRIO system has any effect on the measurement of accommodative response.

Accommodation, Ocular↗
PubMed2002

Rationale and design of HOMED-BP Study: hypertension objective treatment based on measurement by electrical devices of blood pressure study.

BACKGROUND: How far should blood pressure (BP) be lowered to achieve the greatest reduction in the risk of cardiovascular disease? Although a few trials have tried to answer this question, they failed to convincingly establish an optimal target BP level, in part because of poor reproducibility and the wide variability of conventional casual BP measurement they used. At the same time, in Japan, calcium antagonist (Ca-A) and angiotensin-converting enzyme inhibitor (ACE-I) have been two major medications in initial therapy for hypertension, while angiotensin II receptor antagonist (ARB), which has recently been introduced, is also now used widely as an initial therapy. However, no large-scale interventional trial has been conducted to show which of these three initial medications can give the greatest benefit in reducing the risk of cardiovascular disease in the Japanese hypertensive patient. OBJECTIVE: The objectives of the study are, first, to determine an optimal target BP level, based on BP values self-measured at home (home BP). This way of measurement provides more reproducible and less variable BP values than conventional casual measurements. Secondly, we seek to determine the optimal initial antihypertensive medication for the Japanese hypertensive population. METHOD: The study is a 2 x 3 factorial randomized controlled trial conducted with a prospective randomized open-blinded endpoint design. The study will include a total of 9000 untreated essential hypertensive patients aged 40 to 78 years with home BP values > or = 135/85 mmHg. Eligible patients are randomized to one of the two home BP target groups (systolic/diastolic home BP within the range of 134-125/84-80 mmHg, or > or = 125/80 mmHg), and to regimens based on one of three initial antihypertensive drugs (Ca-A or ACE-I or ARB). These randomizations, performed by our host computer, are transmitted to terminals at the outpatient clinic through the Internet. The patient measures BP at home with newly developed equipment (HEM-7471C-N; Omron, Japan) that records BP values, the date, and the time of each measurement. The data are downloaded to the outpatient terminal at every clinic visit then transmitted to the host computer via the Internet. Based on these home BP values, the host computer determines the necessity of additional therapy or dose increments in four further steps to reach the randomized target BP, and then transmits the information to the terminal at the outpatient clinic. The primary study outcome is a composite of non-fatal stroke, non-fatal myocardial infarction, and cardiovascular death. The scheduled average post-randomization duration of follow-up is 7 years. CONCLUSION: This is the first large-scale home BP-based and Internet-connected intervention trial on antihypertensive treatment. The HOMED-BP study (Hypertension Objective treatment based on Measurement by Electrical Devices of BP) will improve the recruitment of general practitioners and participants and will supply unbiased BP data, providing reliable information on optimal target BP levels and the optimal initial antihypertensive medication.

Adult↗
PubMed1977

A computerized obstetric medical record.

Duke University has utilized computerized obstetric medical records since 1971. System evolution is described. Deficiencies in the current system appear to evolve from the computer/human interface rather than from basic system design. Critical elements in system success are physician acceptance of the appearance of data collection sheets and printed notes and continual rapid response in programing modification to allow for physician individuality and changes in medical practice. The limiting factor in the potential usefulness of such a system is the rate of incomplete data collection. It is suggested that if the physician were to enter data directly into the computer through a terminal, data collection would be more accurate and complete.

Computers↗