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PubMed2005

Use of point-of-care online clinical evidence by junior and senior doctors in New South Wales public hospitals.

BACKGROUND: The Clinical Information Access Program (CIAP), an online evidence retrieval system, provides NSW health professionals in public hospitals with 24 h access to information supporting evidence-based practice. AIM: To assess the frequency and type of CIAP usage by senior and junior medical staff and doctors' attitudes to CIAP. METHODS: A convenience sample of 25% of doctors from 65 randomly selected public hospitals completed a survey. Junior (n = 392) and senior (n = 684) doctors' responses were compared using chi2 analyses and t-tests. RESULTS: Most doctors had heard of CIAP (71.8%) and 60.6% had used it. More junior (72.4%) than senior (53.8%) doctors had used CIAP and junior doctors found it easier to use. Of the users 93.5% believed CIAP had the potential to improve patient care; 55.2% had directly experienced this. Most usage (61.5%) occurred at point-of-care; 74% of users found all/most of the information they sought and 71.6% found the search time to be 'good/excellent'. Users had increased their usage in the past year and predicted increased future usage. The most popular databases were Medline and MIMS. Age, access to other evidence, and lack of training, time and computer skills were associated with non-usage. Junior and senior users differed in 4 of 15 reasons for using CIAP. CONCLUSIONS: CIAP is used and valued by the majority of doctors. Patterns of usage, online experiences and the attitudes toward CIAP of senior doctors who use CIAP are relatively similar to those of junior doctors.

Adult↗
PubMed1993

A national survey to assess current use of computerised information systems in obstetrics.

OBJECTIVE: To ascertain the number and type of obstetric computer systems (OCS) in Great Britain, and to ascertain user satisfaction with these systems. DESIGN: A postal questionnaire was circulated to every consultant obstetrician in Great Britain at the beginning of 1992. MAIN OUTCOME MEASURES: Information was sought on the hardware, software and uses of obstetric computer systems. Satisfaction with, benefits and problems of the system were also assessed. RESULTS: There was an 87.5% response rate. Of the 264 units questioned, 100 units reported that they had a computer system. Sixty-five units used terminals connected to a mainframe or minicomputer and 17 used stand-alone personal computers (PCs). Local area networks (LANs) were used in 19 units and wide area network (WANs) in 22 units. Software varied from commercial turnkey systems to in-house systems. The quoted annual running cost ranged from 50 pounds to 48,000 pounds. Most units were satisfied with their system. Problems included slow operating times, unreliability, user unfriendliness, deficiencies in training and inadequate customer support services. CONCLUSIONS: Obstetric computer systems are now coming into widespread use. Despite problems, the use of such systems is likely to increase. This survey establishes a database for those units who are considering acquiring or changing their computer system for the purpose of audit or research.

Attitude to Computers↗
PubMed2001

Linking affiliates electronically.

PROBLEM: Store-and-forward clinical messaging system was cumbersome and inadequate to support modern technology. SOLUTION: Installation of a secure Web-based system that automates communication among physicians, hospitals, clinical laboratories and other departments. RESULTS: Time savings for office personnel and physicians; access by physicians to clinical information anytime, anywhere; consolidation of lab results into one report; customized form--filing capability. KEY TO SUCCESS: Comprehensive and ongoing training to ensure user acceptance.

Computer Communication Networks↗
PubMedDate not supplied

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↗
PubMed2005

Computer-based training in two-dimensional echocardiography using an echocardiography simulator.

Two-dimensional (2D) echocardiography is a user-dependent technique that poses some inherent problems to the beginner. The first problem for beginners is spatial orientation, especially the orientation of the scan plane in reference to the 3-dimensional (3D) geometry of the heart. The second problem for beginners is steering of the ultrasound probe. We have designed a simulator to teach these skills. On a computer screen a side-by-side presentation of a 3D virtual reality scene on the right side and a 2D echocardiographic view on the left side is given. The virtual scene consists of a 3D heart and an ultrasound probe with scan plane. The 2D echocardiographic image is calculated from 3D echocardiographic data sets that are registered with the heart model to achieve spatial and temporal congruency. The displayed 2D echocardiographic image is defined and controlled by the orientation of the virtual scan plane. To teach hand-eye coordination we equipped a dummy transducer with a 3D tracking system and placed it on a dummy torso. We have evaluated the usability of the simulator in an introductory course for final-year medical students. The simulator was graded realistic and easy to use. According to a subjective self-assessment by a standardized questionnaire the aforementioned skills were imparted effectively.

Adult↗
PubMedDate not supplied

Virtual Dementia Tour helps sensitize health care providers.

A review of the literature on sensitivity training among caregivers for the elderly revealed that no programs focused specifically on the cognitive changes that occur due to aging. Second Wind Dreams, a national nonprofit organization committed to improving society's perception of aging, conducted a study in which degenerative physical symptoms common for this population, such as impaired vision and motor skills, were simulated in a group of 146 subjects who worked in the field of elder care to give them a broader sense of the patient's perspective. Overwhelmingly, participants in the study came away with heightened awareness of the plight of confused elders and a strong sense that the high behavioral expectations caregivers have for dementia patients are unrealistic and need to change.

Activities of Daily Living↗
PubMed2003

Measuring use patterns of online journals and databases.

PURPOSE: This research sought to determine use of online biomedical journals and databases and to assess current user characteristics associated with the use of online resources in an academic health sciences center. SETTING: The Library of the Health Sciences-Peoria is a regional site of the University of Illinois at Chicago (UIC) Library with 350 print journals, more than 4,000 online journals, and multiple online databases. METHODOLOGY: A survey was designed to assess online journal use, print journal use, database use, computer literacy levels, and other library user characteristics. A survey was sent through campus mail to all (471) UIC Peoria faculty, residents, and students. RESULTS: Forty-one percent (188) of the surveys were returned. Ninety-eight percent of the students, faculty, and residents reported having convenient access to a computer connected to the Internet. While 53% of the users indicated they searched MEDLINE at least once a week, other databases showed much lower usage. Overall, 71% of respondents indicated a preference for online over print journals when possible. CONCLUSIONS: Users prefer online resources to print, and many choose to access these online resources remotely. Convenience and full-text availability appear to play roles in selecting online resources. The findings of this study suggest that databases without links to full text and online journal collections without links from bibliographic databases will have lower use. These findings have implications for collection development, promotion of library resources, and end-user training.

Computer Literacy↗
PubMed2005

Audiometric testing and hearing protection training through multimedia technology.

The purpose of this paper is to present the development process of a computer-based audiometric testing and tailored intervention program, and assess its feasibility by obtaining users' feedback. The program was implemented for 397 operating engineers at their union training center, and its feasibility was evaluated by obtaining quantitative and qualitative feedback from the participants through a survey and focus group. Over 96% of the participants indicated they liked receiving a hearing test by computer; the computer-based test worked smoothly; and the computer-based training was well organized, effective and held their interests. Almost all (more than 99%) said they would recommend this program to other workers. This project is considered as one of the first ones incorporating multimedia computer technology with self-administered audiometric testing and tailored training. Participants' favorable feedback strongly supported the continued utilization of this approach for designing and developing health screening and intervention to promote healthy behaviors.

Adult↗
PubMedDate not supplied

Can community health workers screen under 5 yr children with computer program.

EKALAVYA computer program aims at high risk screening of under 5 children in Primary Health Centers by Community Health Workers (CHWs) simulating existing programs like CSSM, ICDS etc. This integrates many common symptoms like fever, respiratory, diarrhea, convulsions etc. along with health promotional aspects like growth, immunization etc. at Community Health Workers skills level. EKALAVYA program was user friendly for CHWs who were trained in 2-3 weeks. CHWs with computer guidance were compared with clinical evaluation of Research Team in 96 pediatric OPD cases in a teaching institution. Overall concordance was 91.66%. Symptom wise and severity wise analysis also showed good concordance. The study also indicated training and programme errors which could be easily corrected. EKALAVYA Program is now ready for field trial in PHCs for the guidance of CHWs in decision making.

Child Health Services↗
PubMed2003

Human factors in air traffic control: problems at the interfaces.

The triangular ISIS model for describing the operation of human factors in complex sociotechnical organisations or systems is applied in this research to a large international air traffic control system. A large sample of senior Air Traffic Controllers were randomly assigned to small focus discussion groups, whose task was to identify problems occurring at the interfaces of the three major human factor components: individual, system impacts, and social. From these discussions, a number of significant interface problems, which could adversely affect the functioning of the Air Traffic Control System, emerged. The majority of these occurred at the Individual-System Impact and Individual-Social interfaces and involved a perceived need for further interface centered training.

Accidents, Aviation↗
PubMed1998

A vascular catheterization simulator for training and treatment planning.

We have developed a working prototype of an augmented reality based vascular catheterization simulator. The simulator is called daVinci, and provides the interventional radiologists with a "hands on, user friendly, image based environment to augment training, enhance pretreatment planning and design interventional products and devices. daVinci is based on computational modeling of human anatomical images and provides the user with capabilities for realtime simulated navigation of catheters in both 2-D and 3-D modeled vessels. In addition, multiplaner CT, MRI and anatomical data sets are incorporated into the simulator to enhance the understanding of anatomical relationships associated with vascular catheterization procedures. The current prototype is designed for peripheral vascular applications. Additional systems are currently being considered for both interventional neuroradiology and cardiology.

Angiography↗
PubMed1998

Using computer modeling to help identify patient subgroups in clinical data repositories.

OBJECTIVE: The ability to accurately and efficiently identify patient cases of interest in a hospital information system has many important clinical, research, educational and administrative uses. The identification of cases of interest sometimes can be difficult. This paper describes a two-stage method for searching for cases of interest. DESIGN: First, a Boolean search is performed using coded database variables. The user classifies the retrieved cases as being of interest or not. Second, based on the user-classified cases, a computer model of the patient cases of interest is constructed. The model is then used to help locate additional cases. These cases provide an augmented training set for constructing a new computer model of the cases of interest. This cycle of modeling and user classification continues until halted by the user. MEASUREMENTS: This paper describes a pilot study in which this method is used to identify the records of patients who have venous thrombosis. RESULTS: The results indicate that computer modeling enhances the identification of patient cases of interest.

Bayes Theorem↗
PubMed1984

Exercise and sports equipment: some ergonomics aspects.

Sports equipment encompasses a gamut of devices used in laboratory, training and competitive contexts and these form the content of this paper. Ergometers range in sophistication from friction braked stationary bicycles to computer controlled simulators which incorporate exercise modes specific to the athletic user. These are now used in training, as experimental devices and in some instances for competition purposes. Training equipment exhibits a similar emphasis on exercise specificity, safety being an important aspect of its use. Design of projectiles for sporting activities has mainly reflected their traditional modes of use, the introduction of synthetic materials having some ergonomics implications. Similarly, materials science and design technology have contributed innovations in equipment for racquet sports and hitting implements. The changes have tended to be associated with availability of new materials for product construction and have implications for safety and skill in the transition to using the new products. Ski equipment design illustrates ergonomics factors in interfacing the performer with the sporting environment and how equipment has progressed by regenerative design processes. Enhancement of performance in some sports must be accompanied by an awareness of safety requirements: where appropriate, risks to participants should be reduced by use of protective clothing and equipment. Enforced validation of protective equipment is recommended to raise safety levels in certain sports and the safety of spectators must not be neglected. Human factors criteria can then be applied in monitoring, officiating and spectating at sporting events.

Journal Article↗
PubMed1999

Learning how to perform a 12 lead ECG using virtual reality.

The most common cardiac examination ordered by physicians is the 12 lead ECG, frequently obtained with a computerized recording device that not only provides the ECG tracing but, may also provide the diagnosis. In the past, only persons working in the ECG laboratory were allowed to perform a 12 lead ECG on a patient. Today, however, this task has been delegated to a variety of health professionals, including registered nurses, licensed practice nurses, and even nursing assistants in some health care facilities. New nurses are taught the skill of obtaining a 12 lead ECG during their initial hospital orientation. Because of this, it is not uncommon to have staff development nurses teaching groups of health professionals how to perform a 12 lead ECG content and skill as many as 5 times in 1 week. For delivery of repetitive content, the use of an interactive CD ROM can be very cost effective. Many health care institutions purchase commercially made CD ROM products, while elsewhere nurse educators develop their own. An interactive CD ROM based on the principles of best practice in education and using embedded virtual reality, was designed by the author to teach nurses, students, and other health professionals how to perform a 12 lead ECG. This article will: 1) describe the interactive CD ROM reality as a teaching methodology; 2) discuss the preliminary evaluation of learning outcomes using CD ROM as the instructional method; and 3) describe the applications interactive CD ROMs may have in nursing practice and education.

CD-ROM↗
PubMed2004

A brain-computer interface using electrocorticographic signals in humans.

Brain-computer interfaces (BCIs) enable users to control devices with electroencephalographic (EEG) activity from the scalp or with single-neuron activity from within the brain. Both methods have disadvantages: EEG has limited resolution and requires extensive training, while single-neuron recording entails significant clinical risks and has limited stability. We demonstrate here for the first time that electrocorticographic (ECoG) activity recorded from the surface of the brain can enable users to control a one-dimensional computer cursor rapidly and accurately. We first identified ECoG signals that were associated with different types of motor and speech imagery. Over brief training periods of 3-24 min, four patients then used these signals to master closed-loop control and to achieve success rates of 74-100% in a one-dimensional binary task. In additional open-loop experiments, we found that ECoG signals at frequencies up to 180 Hz encoded substantial information about the direction of two-dimensional joystick movements. Our results suggest that an ECoG-based BCI could provide for people with severe motor disabilities a non-muscular communication and control option that is more powerful than EEG-based BCIs and is potentially more stable and less traumatic than BCIs that use electrodes penetrating the brain.

Adult↗
PubMed1986

EXPERFARM: a new package in BASIC for teaching genetics.

We have developed two interactive computer programs (together referred to as EXPERFARM), which enable simulation of a great variety of genetic situations. This package is designed for teaching basic genetics as well as quantitative and population genetics. The main advantages of EXPERFARM are its great versatility, as different situations can be simulated by simply changing the inputs, and the small amount of training necessary for the users.

Computer-Assisted Instruction↗
PubMed2000

Evaluation of a manual wheelchair interface to computer games.

The sedentary lifestyle of many people with spinal cord injury (SCI) has lead to cardiovascular diseases being a major health concern. A suitable exercise program may help improve the SCI individual's cardiovascular fitness level. GAMEWheels is an interface between a custom wheelchair roller system and a computer that enables an individual to control computer video games by driving his or her wheelchair. The purpose of Phase 1 was to evaluate the design of the GAMEWheels system and to determine the type of computer video game that is likely to motivate wheelchair users to exercise. Phase 2 included physiologic testing of wheelchair users and the GAMEWheels system to investigate whether the system elicits an exercise training response. Thirty-five subjects were recruited to evaluate the GAMEWheels by playing three commercial computer games (Phase 1) and to identify the computer game that they would prefer to use when exercising. The feedback from Phase 1 was used with test subjects to verify that the GAMEWheels system elicits an exercise training effect (Phase 2). Phase 2 included 10 subjects using the GAMEWheels system to play Need for Speed II. During game play, physiologic data were collected and the subjects' oxygen consumption and heart rate were analyzed. Analysis showed that the GAMEWheels system induced nine subjects to reach their training zone, defined as 50% and 60% of their maximum oxygen consumption and heart rate, respectively. This study demonstrates that the GAMEWheels system elicits an exercise training response.

Adult↗