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Product-related emphasis of skin disease information online.

BACKGROUND: In 2000, 41 million people searched for medical information online. The quality of that information is unregulated, variable, and not well studied. OBJECTIVE: To quantify and compare the numbers and types of Internet sites matched for 10 diverse skin conditions through different search systems. DESIGN: Search strategies were performed at 6-month intervals via Netscape Navigator, using 3 search engines and 1 directory. Ten skin conditions were chosen to represent common (psoriasis and eczema), cosmetic (wrinkles and cellulite), difficult-to-treat (alopecia, mastocytosis, granuloma annulare, and xanthoma), and uncommon (dermatitis herpetiformis and epidermolysis bullosa) problems. Search strings were designed to generate lists of Web sites that provide educational or product-related information. Results were compared. SETTING: The Saint Louis University information technology server, July 9, 1999, December 16, 1999, and February 5, 2000. MAIN OUTCOME MEASURES: Comparisons of the total number, top 10 ranking, and type (educational vs product-related) of sites that matched through different search systems at 6-month intervals. RESULTS: The total number of matched sites for different skin conditions varied up to 100-fold. This number increased by 30% to 316% between July and December 1999. The largest number of Web sites related to wrinkles, followed by Web sites related to common conditions. Product-related sites outnumbered educational sites, especially for common and cosmetic conditions. Although there were differences in the total number of sites found through different search engines, the ratios of product-related to educational sites were similar. Different search engines yielded different top 10 match lists for the same condition. The top 10 lists included higher proportions of educational sites than the total match lists for all conditions except cellulite. Within the top 10 lists, the rank order of well respected sites varied by search engine used and changed over time. CONCLUSIONS: Patients are increasingly accessing the growing body of data available through the Internet. Most Web sites contain information related to products. Until standards are enacted to govern the distribution of online medical information, consumers are at risk for obtaining misinformation and buying ineffective products. To better guide patients, physicians must become familiar with this ever-changing information.

Female↗

Carbohydrate characterization of recombinant glycoproteins of pharmaceutical interest.

Carbohydrate characterization of recombinant glycoproteins entails determination of the primary structures and points of attachment of the oligosaccharide moieties. This article reviews several methods for oligosaccharide- and glycosylation-site characterization. A major recent advance in carbohydrate analysis has been the use of high-pH anion exchange (HPAE) chromatography for separation of glycoprotein-derived oligosaccharides. These separations are sensitive to molecular size, carbohydrate composition, linkage positions, and anomeric configurations. As a result, HPAE chromatography is a powerful technique for glycoprotein characterization and can serve as the basis of an "oligosaccharide map." Characterization of potential N-glycosylation sites involves determining whether each potential site is glycosylated, the extent of oligosaccharide processing at each site, and ideally, a detailed description of the distribution of oligosaccharides at each site. Several approaches to characterizing glycosylation sites are described, including peptide mapping and mass spectrometry. Treatment of a glycoprotein with endo-beta-N-acetylglucosaminidase H (endo H) followed by peptide:N-glycosidase F (PNGase F) can be used to distinguish sites that are not glycosylated from those carrying high-mannose structures and from those containing attached complex oligosaccharides. After individual glycosylation sites have been labeled by this series of reaction, the resulting peptides are characterized by automated Edman degradation. This technique is particularly valuable for characterizing peptides that contain more than one potential N-glycosylation site. An example is also given in which HPAE chromatography is used in conjunction with reversed-phase high-performance liquid chromatography tryptic mapping to obtain detailed information on the distribution of oligosaccharides at individual glycosylation sites.

Carbohydrate Sequence↗

Cardiopulmonary resuscitation and contrast media reactions in a radiology department.

AIM: To assess current knowledge and training in the management of contrast media reactions and cardiopulmonary resuscitation within a radiology department. MATERIALS AND METHODS: The standard of knowledge about the management of contrast media reactions and cardiopulmonary resuscitation among radiologists, radiographers and nurses were audited using a two-section questionnaire. Our results were compared against nationally accepted standards. Repeat audits were undertaken over a 28-month period. Three full audit cycles were completed. RESULTS: The initial audit confirmed that although a voluntary training programme was in place, knowledge of cardiopulmonary resuscitation techniques were below acceptable levels (set at 70%) for all staff members. The mean score for radiologists was 50%. Immediate changes instituted included retraining courses, the distribution of standard guidelines and the composition and distribution of two separate information handouts. Initial improvements were complemented by new wallcharts, which were distributed throughout the department, a series of lectures on management of contrast reactions and regular reviews with feedback to staff. In the third and final audit all staff groups had surpassed the required standard. CONCLUSION: Knowledge of contrast media reactions and resuscitation needs constant updating. Revision of skills requires a prescriptive programme; visual display of advice is a constant reminder. It is our contention all radiology departmental staff should consider it a personal duty to maintain their resuscitation skills at appropriate standards.

Cardiopulmonary Resuscitation↗

Reconstruction of two victims' posturing based on the induced radioactivities in their bones in the criticality accident in Tokai-Mura, Japan.

On 30 September 1999, three workers were severely exposed to neutrons and gamma rays in a criticality accident that occurred at a uranium conversion facility in Tokai-mura, Ibaraki Prefecture, Japan. Radiochemical analyses of 32P and 45Ca induced by neutrons in bone matrix were carried out after the deaths of two of the victims. It was found that more than several million becquerels of both nuclides had been produced in their body skeletons. Results showed non-homogeneous distributions of neutron fluence in the bodies, from which it could be deduced how both workers were positioned relative to the fission source during exposure, i.e., at the moment of the first nuclear excursion. For the victim who died first, the activities in the central part of his body were more than those of his extremities. Also, in the central part of his body, the right side showed more activities than the left side. As for the second man, the activities indicated rather uniform exposure to neutrons to the whole body although the geometrical distribution of the activity varied enough to assume his orientation. Such information on the geometrical distribution of neutron-induced radioactivities in the skeleton can be used to reconstruct the posturing of the victims, which is necessary to estimate their apparent absorbed doses.

Bone and Bones↗

Multiscale simulation of loading and electrical resistance in silicon nanoindentation

Nanoindentation experiments are an excellent probe of micromechanical properties, but their interpretation is complicated by their multiscale nature. We report simulations of silicon nanoindentation, based on an extended version of the local quasicontinuum model, capable of handling complex Bravais crystals. Our simulations reproduce the experimental load vs displacement curves and provide microscopic information such as the distribution of transformed metallic phases of silicon underneath the indenter. This information is linked to the macroscopic electrical resistance, giving a satisfactory explanation of experimental results.

Journal Article↗

Arsenic distribution in Florida urban soils: comparison between Gainesville and Miami.

Arsenic contamination is of concern due to its effect as a carcinogen. Understanding the distribution of arsenic in urban soils is important for establishing baseline concentrations from which anthropogenic effects can be measured. The soil cleanup target level (SCTL) for arsenic in Florida (0.8 and 3.7 mg kg(-1) in residential and commercial areas, respectively) is lower than in most states and is near the arsenic background concentrations in Florida soils. The objective of this study was to characterize the distribution of arsenic in the soils of two Florida cities, Gainesville and Miami. More than 200 soil samples were collected from three land-use classes in each city (residential, commercial, and public land), digested with USEPA Method 3051a, and analyzed with graphite furnace atomic absorption spectrophotometry. Arsenic concentrations varied greatly in Gainesville, ranging from 0.21 to approximately 660 mg kg(-1) with a geometric mean (GM) of 0.40 mg kg(-1) (after discarding outliers), which was significantly lower than the GM of 2.81 mg kg(-1) in Miami, although Miami samples ranged only from 0.32 to approximately 110 mg kg(-1). Arsenic concentrations in 29 and 4% of the Gainesville soil samples and 95 and 33% of the Miami samples exceeded the Florida residential and commercial SCTL, respectively. This study is the first to provide information on arsenic distribution in urban soils of Florida, and the data are useful for assessing arsenic contamination and determining the need for remediation.

Arsenic↗

The AIDS research agenda at the National Institutes of Health.

The foundation, goals, and components of the research strategy developed by the National Institutes of Health to combat AIDS and HIV infection are discussed. The AIDS research agenda, based on systems originally designed to coordinate cancer research, involves a national effort to study various aspects of the disease, disseminate information, and rapidly develop and test drugs and vaccines to treat and prevent AIDS and HIV disease. AIDS research makes up approximately 10% of the total NIH budget of $7.6 billion, and the largest portion of that allocation goes to improving current treatments and developing new agents. Drug discovery efforts are supported by the National Institute of Allergy and Infectious Diseases (NIAID) through the Division of Intramural Research, in which biomedical and clinical research is conducted, and the Division of AIDS, which coordinates extramural research in university-based centers and community programs. By providing educational materials and sponsoring conferences, NIAID also helps to disseminate the results of the research it coordinates. Pharmacists support AIDS research through their involvement with study drug products and their role in protocol development, regulatory affairs, product development, and accumulation and distribution of drug information. Research initiatives sponsored by the federal government combine resources of investigators from government, academia, and the pharmaceutical and biotechnological industries to meet the challenges posed by the AIDS epidemic.

Acquired Immunodeficiency Syndrome↗

Evaluation of UltraSTAR: performance of a collaborative structured data entry system.

The UltraSTAR structured data entry system is now in routine use for reporting ultrasound studies at Brigham and Women's Hospital, having been used for 3722 reports in its first ten months of service. Reports entered through GUI-based forms are uploaded via HL7 to a radiology information system and distributed through a hospital network. UltraSTAR introduces collaborative reporting, in which nonmedical and medical staff collaborate to produce a single report for each patient visit. Performance of UltraSTAR was measured as user satisfaction, data entry time, report completeness, free text annotation rate, and referring-physician satisfaction with reports. Results show high satisfaction with UltraSTAR among radiologists and acceptance of the system among ultrasound technicians. Data entry times averaged 5.3 minutes per report. UltraSTAR reports were slightly more complete than comparable narrative reports. Free text annotations were needed in only 25.2% of all UltraSTAR reports. Referring physicians were neutral to slightly positive toward UltraSTAR's outline-format reports. UltraSTAR is successful at structured data entry despite somewhat long reporting times. Its success can be attributed to efficiencies from collaborative reporting and from integration with existing information systems. UltraSTAR shows that the advantages of structured data entry can outweigh its difficulties even before problems of data entry time and concept representation are solved.

Attitude to Computers↗

Development and implementation of outreach strategies for breast and cervical cancer prevention among African American women. FoCaS Project. Forsyth County Cancer Screening.

BACKGROUND: The purpose of the FoCaS (Forsyth County Cancer Screening) Project was to develop and implement strategies that would improve the beliefs, attitudes, and preventive health habits of populations typically considered hard to reach. Conventional health education methods have not produced substantial results; thus, innovative and unusual strategies are needed. METHODS: The FoCaS project implemented specific methods to reach the targeted population of African American women aged 40 and older that resides in public housing communities. Five outreach strategies were used: 1) educational classes (group setting and one-on-one sessions) on various topics that relate not to breast and cervical cancer but to women's issues in general; 2) media campaigns strategically scheduled throughout the year; 3) the inclusion of religion in educational classes and community outreach; 4) the use of information centers to distribute materials; and 5) a community-wide cancer-awareness event. RESULTS: These strategies reached women in nonthreatening environments that permitted heavy involvement and easy understanding of the importance of breast and cervical cancer screening. CONCLUSION: The effects of these strategies on promoting screening will be evaluated using data from the follow-up survey conducted during the spring of 1996.

Adult↗

Medicinal use and social status of the soap berry endod (Phytolacca dodecandra) in Ethiopia.

Berries from Phytolacca dodecandra L'Herit. (endod in Amharic) offer a readily available molluscicide to control schistosomiasis. Parts of the endod plant have been used as a detergent and as traditional medicine for centuries in Ethiopia. An interview survey was performed in the highlands of Ethiopia to provide information on the distribution of the plant, people's traditional use of it, their perception of the plant, and the potential for increased production and use of endod as a soap for indirect control of schistosomiasis. People of all ages report that they are familiar with the plant and its detergent and medicinal uses. The plant is largely disappearing from unprotected areas due to land clearing. Younger people appear to use endod as a soap whenever it is available. Older women prefer commercial soap and consider endod to be associated with poor people. Common medicinal uses include treatment of skin itching (ringworm), abortion, gonorrhea, leeches, intestinal worms, anthrax and rabies. Two thirds of the people express interest in cultivating endod for personal use if supplied with rooted cuttings. Increased cultivation of endod and use of berries for washing might be possible if information about schistosomiasis and its control is disseminated among people. Preference for commercial soap and lack of land for cultivation are major obstacles for increasing the availability and use of endod.

Adolescent↗

The cognitive complexity of a provider order entry interface.

Computer-based provider order entry (POE) can reduce the frequency of preventable medical errors. However, overly complex interfaces frequently pose a challenge to users and impede clinical efficacy. We present a cognitive analysis of clinician interaction with a commercial POE system. Our investigation was informed by the distributed resources model, a novel approach designed to describe the dimensions of user interfaces that introduce unnecessary cognitive complexity. This approach characterizes the relative distribution of user's internal representations and external representations embodied in the system or environmental artifacts. The research consisted of two component analyses: a modified cognitive walkthrough evaluation and a simulated clinical ordering task performed by seven physicians. The analysis revealed that the configuration of resources placed unnecessarily heavy cognitive demands on the user, especially those who lacked a robust conceptual model of the system. The resources model was also used to account for patterns of errors produced by clinicians.

Cognition↗

Estimating ECG distributions from small numbers of leads.

The utility of body surface potential mapping to improve interpretation of electrocardiographic information lies in the presentation of thoracic surface distributions to characterize underlying electrophysiology less ambiguously than that afforded by conventional electrocardiography. Localized cardiac disease or abnormal electrophysiology presents itself electrocardiographically on the body surface in a manner in which pattern plays an important role for identifying or characterizing these abnormalities. Thus, in myocardial infarction, transient myocardial ischemia, Wolff-Parkinson-White syndrome, or ventricular ectopy, observation of electrocardiographic potential patterns, their extrema, and their magnitudes permits localization and quantization of the abnormal activity. Conventional electrocardiography assesses pattern information incompletely and does not use information of distribution extrema locations or magnitudes. Thus, increases or decreases in the magnitudes of electrocardiographic features (ST-segment potential displacement, amplitude, or morphology of Q, R, S, or T waves) associated with changes in cardiac sources (ischemia, infarction, conduction abnormalities, etc.) as measured from fixed leads have a high likelihood of being misinterpreted if the distribution itself is changing. In this study, the authors demonstrate the utility of estimating distributions from small numbers of optimally selected leads, including conventional leads, to reduce uncertainty in the interpretation of electrocardiographic information. This issue is highly relevant when thresholds are used to detect significance of potential levels (exercise testing, detection of myocardial infarction, and continuous monitoring to assess ST-segment changes). Significance of this work lies in improved detection and characterization of abnormal electrophysiology using conventional or enhanced leadsets and methods to estimate thoracic potential distributions.

Angioplasty, Balloon, Coronary↗

Determination of a site-specific reference dose for methylmercury for fish-eating populations.

Environmental risk-management decisions in the U.S. involving potential exposures to methylmercury currently use a reference dose (RfD) developed by the U.S. Environmental Protection Agency (USEPA). This RfD is based on retrospective studies of an acute poisoning incident in Iraq in which grain contaminated with a methylmercury fungicide was inadvertently used in the baking of bread. The exposures, which were relatively high but lasted only a few months, were associated with neurological effects in both adults (primarily paresthesia) and infants (late walking, late talking, etc.). It is generally believed that the developing fetus represents a particularly sensitive subpopulation for the neurological effects of methylmercury. The USEPA derived an RfD of 0.1 microg/kg/day based on benchmark dose (BMD) modeling of the combined neurological endpoints reported for children exposed in utero. This RfD included an uncertainty factor of 10 to consider human pharmacokinetic variability and database limitations (lack of data on multigeneration effects or possible long-term sequelae of perinatal exposure). Alcoa signed an Administrative Order of Consent for the conduct of a remedial investigation/feasibility study (RI/FS) at their Point Comfort Operations and the adjacent Lavaca Bay in Texas to address the effects of historical discharges of mercury-containing wastewater. In cooperation with the Texas Natural Resource Conservation Commission and USEPA Region VI, Alcoa conducted a baseline risk assessment to assess potential risk to human health and the environment. As a part of this assessment. Alcoa pursued the development of a site-specific RfD for methylmercury to specifically address the potential human health effects associated with the ingestion of contaminated finfish and shellfish from Lavaca Bay. Application of the published USEPA RfD to this site is problematic; while the study underlying the RfD represented acute exposure to relatively high concentrations of methylmercury, the exposures of concern for the Point Comfort site are from the chronic consumption of relatively low concentrations of methylmercury in fish. Since the publication of the USEPA RfD, several analyses of chronic exposure to methylmercury in fish-eating populations have been reported. The purpose of the analysis reported here was to evaluate the possibility of deriving an RfD for methylmercury, specifically for the case of fish ingestion, on the basis of these new studies. In order to better support the risk-management decisions associated with developing a remediation approach for the site in question, the analysis was designed to provide information on the distribution of acceptable ingestion rates across a population, which could reasonably be expected to be consistent with the results of the epidemiological studies of other fish-eating populations. Based on a review of the available literature on the effects of methylmercury, a study conducted with a population in the Seychelles Islands was selected as the critical study for this analysis. The exposures to methylmercury in this population result from chronic, multigenerational ingestion of contaminated fish. This prospective study was carefully conducted and analyzed, included a large cohort of mother-infant pairs, and was relatively free of confounding factors. The results of this study are essentially negative, and a no-observed-adverse-effect level (NOAEL) derived from the estimated exposures has recently been used by the Agency for Toxic Substances and Disease Registry (ATSDR) as the basis for a chronic oral minimal risk level (MRL) for methylmercury. In spite of the fact that no statistically significant effects were observed in this study, the data as reported are suitable for dose-response analysis using the BMD method. Evaluation of the BMD method used in this analysis, as well as in the current USEPA RfD, has demonstrated that the resulting 95% lower bound on the 10% benchmark dose (BMDL) represents a conservative estimate of the traditional NOAEL, and that it is superior to the use of "average" or "grouped" exposure estimates when dose-response information is available, as is the case for the Seychelles study. A more recent study in the Faroe Islands, which did report statistically significant associations between methylmercury exposure and neurological effects, could not be used for dose-response modeling due to inadequate reporting of the data and confounding from co-exposure to polychlorinated biphenyls (PCBs). BMD modeling over the wide range of neurological endpoints reported in the Seychelles study yielded a lowest BMDL for methylmercury in maternal hair of 21 ppm. This BMDL was then converted to an expected distribution of daily ingestion rates across a population using Monte Carlo analysis with a physiologically based pharmacokinetic (PBPK) model to evaluate the impact of interindividual variability. The resulting distribution of ingestion rates at the BMDL had a geometric mean of 1.60 microg/kg/day with a geometric standard deviation of 1.33; the 1st, 5th, and 10th percentiles of the distribution were 0.86, 1.04, and 1.15 microg/kg/day. In place of the use of an uncertainty factor of 3 for pharmacokinetic variability, as is done in the current RfD, one of these lower percentiles of the daily ingestion rate distribution provides a scientifically based, conservative basis for taking into consideration the impact of pharmacokinetic variability across the population. On the other hand, it was felt that an uncertainty factor of 3 for database limitations should be used in the current analysis. Although there can be high confidence in the benchmark-estimated NOAEL of 21 ppm in the Seychelles study, some results in the New Zealand and Faroe Islands studies could be construed to suggest the possibility of effects at maternal hair concentrations below 10 ppm. In addition, while concerns regarding the possibility of chronic sequelae are not supported by the available data, neither can they be absolutely ruled out. The use of an uncertainty factor of 3 is equivalent to using a NOAEL of 7 ppm in maternal hair, which provides additional protection against the possibility that effects could occur at lower concentrations in some populations. Based on the analysis described above, the distribution of acceptable daily ingestion rates (RfDs) recommended to serve as the basis for site-specific risk-management decisions at Alcoa's Point Comfort Operations ranges from approximately 0.3 to 1.1 microg/kg/day, with a population median (50th percentile) of 0.5 microg/kg/day. By analogy with USEPA guidelines for the use of percentiles in applications of distributions in exposure assessments, the 10th percentile provides a reasonably conservative measure. On this basis, a site-specific RfD of 0.4 microg/kg/day is recommended.

Adult↗

A statewide decentralized public drug information system.

A statewide drug information system designed to assist consumers and health professionals is described, with emphasis on the training of pharmacists in the system's satellites. The development of the system was initially funded by a 10-month, $12,500 grant from the Chemical Dependency Division of the State of Minnesota Department of Public Welfare. Twenty-one satellite drug information centers in community or hospital pharmacies are linked by a WATS telephone line to the library of the University of Minnesota College of Pharmacy. Consumers' questions are handled through the satellites with the pharmacists there referring to the central information source as needed. All the pharmacists in the system are trained in a one and one-half day program that covers (1) consultation skills, (2) communication skills, (3) drug information retrieval and distribution, (4) practical applications, (5) promotion, and (6) resources and referrals. The average amount of time devoted to the service for all pharmacy sites is 15-20 minutes per day. Percentage of time that specific resources are used include one's own knowledge and experience, 64.8%; a fellow pharmacist, 5.7%; another resource individual, 5.1%; a standard pharmacy reference book, 13.4%; the central clearinghouse at the college, 6.2%; and another resource facility, 4.8%. The authors believe that their system can be easily adapted to other areas.

Community Pharmacy Services↗

Strain distribution in the ligament using photoelasticity. A direct application to the human ACL.

Large and highly variable deformations of the anterior cruciate ligament (ACL) in the human knee cannot be adequately quantified by one-dimensional and/or localized measurements. In order to measure strains in the entire area of the ACL, we employed the photoelastic coating method to analyze stress on the basis of the strains. A specific kind of polyurethane possessing optically high fringe-sensitivity was found to be most suitable for the measurement purposes. Although the photoelastic method has been successfully applied in various fields for stress analyses, its use in studying large deformations of biological tissues has not been reported. Therefore, before proceeding with our main study, we first examined the effects of polyurethane film on the mechanical properties of the ligament. We found that the film had a negligible effect on the tissues' properties, and closely reflected the strain behavior of the tissues. We then applied the method to measure strains on an actual ACL during free flexion-extension of the knee. A specially designed apparatus was used to allow a natural motion of the knee. A portion of the femoral bone was removed to expose the ACL to view. Measurement and analysis gave continuous information about strain distribution, including the variations of strain along the principal strain directions in the ACL.

Animals↗

Self-reported health in Bulgaria: levels and determinants.

AIMS: Self-reported health has been widely used in studies of health inequalities in many industrialized countries, but there is still little information on their distribution within populations in countries in Central and Eastern Europe (CEE). There is growing evidence that, since the political transition at the end of the 1980s, income and health inequalities have widened considerably throughout CEE. This paper examined self-perceived health in Bulgaria in relation to financial status (measured by income and self-assessed financial status) after adjustment for other potential explanatory variables. METHODS: Data were derived from a national representative survey of the population of Bulgaria aged over 18, in 1997. Respondents were asked "How would you describe your own health status over the past 12 months on the whole?" with answers "good", "rather good", "rather poor", and "poor". Responses were assessed in relation to a variety of measures including income, education, marital status, and self-perceived financial hardship. RESULTS: As expected, the prevalence of poor/rather poor health increases steeply with age. Those with only primary education are more likely to be in poor/rather poor health than those with secondary or higher education. Self-assessed financial status is a much better predictor of health than is income, with the relationship especially strong among women. There was no association with marital status or urban vs. rural dwelling. CONCLUSIONS: The survey found marked inequalities in self-reported health in Bulgaria. Some of its determinants, such as age and education, are comparable to those seen in the West. Self-reported health is particularly associated with self-perceived financial hardship, a proxy for material deprivation that is sensitive to informal economic exchanges. An accelerated pace of economic and social reforms at the end of the 1990s means that the health divisions in Bulgaria are likely to increase in the short term.

Adult↗

A framework for analyzing the cognitive complexity of computer-assisted clinical ordering.

Computer-assisted provider order entry is a technology that is designed to expedite medical ordering and to reduce the frequency of preventable errors. This paper presents a multifaceted cognitive methodology for the characterization of cognitive demands of a medical information system. Our investigation was informed by the distributed resources (DR) model, a novel approach designed to describe the dimensions of user interfaces that introduce unnecessary cognitive complexity. This method evaluates the relative distribution of external (system) and internal (user) representations embodied in system interaction. We conducted an expert walkthrough evaluation of a commercial order entry system, followed by a simulated clinical ordering task performed by seven clinicians. The DR model was employed to explain variation in user performance and to characterize the relationship of resource distribution and ordering errors. The analysis revealed that the configuration of resources in this ordering application placed unnecessarily heavy cognitive demands on the user, especially on those who lacked a robust conceptual model of the system. The resources model also provided some insight into clinicians' interactive strategies and patterns of associated errors. Implications for user training and interface design based on the principles of human-computer interaction in the medical domain are discussed.

Cognition↗

Changing an automated drug inventory control system to a data base design.

A pharmacy department's change from indexed sequential access files to a data base management system (DBMS) for purposes of automated inventory control is described. The DBMS has three main functional areas: (1) inventory ordering and accountability, (2) charging of interdepartmental and intradepartmental orders, and (3) data manipulation with report design for management control. There are seven files directly related to the inventory ordering and accountability area. Each record can be accessed directly or through another file. Information on the quantity of a drug on hand, drug(s) supplied by a specific vendor, status of a purchase order, or calculation of an estimated order quantity can be retrieved quickly. In the drug master file, two records contain a reorder point and safety-stock level that are determined by searching the entries in the order history file and vendor master file. The intradepartmental and interdepartmental orders section contains five files assigned to record and store information on drug distribution. All items removed from the stockroom and distributed are recorded, and reports can be generated for itemized bills, total cost by area, and as formatted files for the accounts payable department. The design, development, and implementation of the DBMS took approximately a year using a part-time pharmacist and minimal outside help, while the previous system required constant expensive help of a programmer/analyst. The DBMS has given the pharmacy department a flexible inventory management system with increased drug control, decreased operating expenses, increased use of department personnel, and the ability to develop and enhance other systems.

Computers↗