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PubMed1983

Acceptability of computer-acquired sexual histories in adolescent girls.

We investigated the acceptability and reliability of sensitive data collected via computer in adolescent patients. Subjects were 108 adolescent girls (ages 14 to 20 years), randomly assigned to one of three groups: (1) interactive computer interview, (2) face-to-face interview, or (3) self-administered questionnaire. Subjects were queried about their general health and sexual behavior. Adolescents interviewed by computer were more likely than subjects in other groups to state that they enjoyed the survey (P less than 0.001). There were no differences in anxiety or the reporting of sexual behavior among subjects in the three groups. Adolescents who stated that they would prefer a computer interview (40%) said they would be more comfortable with the computer, and perceived the method as being fun, interesting, confidential, private, and easy. Computer interviews cannot replace the skills of a sensitive physician, but may be an acceptable and valid means of collecting information from adolescents under certain conditions.

Adolescent↗
PubMed2000

Hand-held computer operating system program for collection of resident experience data.

OBJECTIVE: To describe a system for recording resident experience involving hand-held computers with the Palm Operating System (3 Com, Inc., Santa Clara, CA). PROGRAM DESCRIPTION: Hand-held personal computers (PCs) are popular, easy to use, inexpensive, portable, and can share data among other operating systems. Residents in our program carry individual hand-held database computers to record Residency Review Committee (RRC) reportable patient encounters. Each resident's data is transferred to a single central relational database compatible with Microsoft Access (Microsoft Corporation, Redmond, WA). Patient data entry and subsequent transfer to a central database is accomplished with commercially available software that requires minimal computer expertise to implement and maintain. The central database can then be used for statistical analysis or to create required RRC resident experience reports. As a result, the data collection and transfer process takes less time for residents and program director alike, than paper-based or central computer-based systems. CONCLUSION: The system of collecting resident encounter data using hand-held computers with the Palm Operating System is easy to use, relatively inexpensive, accurate, and secure. The user-friendly system provides prompt, complete, and accurate data, enhancing the education of residents while facilitating the job of the program director.

Computer Communication Networks↗
PubMed1990

Micro-computers: availability to and use by trainees in public health medicine.

A survey of the availability to and use of micro-computers by public health medicine trainees was undertaken in February, 1989. Most departments have access to computers and trainees possess computing skills, but almost one in 15 trainees had no access to a micro-computer, and one trainee in eleven had no computing experience while a further one in eight had not progressed beyond word-processing. Departments of Public Health Medicine should review their computing resources and ensure that they are adequate for the challenges of the 1990s.

Computer User Training↗
PubMed1996

Accuracy of high-resolution computed tomography in cochlear implantation.

Multichannel cochlear implants are a proven method for the auditory rehabilitation of individuals who have severe-to-profound sensorineural hearing loss. These devices typically require insertion into the scala tympani of the cochlea to provide auditory stimulations. A patent scala provides the best chance for an adequate insertion of the electrode array. Preoperative high-resolution computed tomography imaging has traditionally been used to determine the patency of the scala tympani. Its ability to accurately predict the patency of the cochlea has been questioned in several retrospective studies. A prospective study was undertaken in 28 consecutive individuals undergoing cochlear implant surgery to compare the findings on high-resolution computed tomography with the surgical findings in an attempt to determine high-resolution computed tomography's accuracy. Cochlear obstruction caused by ossification was accurately predicted in six of six individuals but overestimated in the round window region in three individuals. High-resolution computed tomography accurately predicted patent cochleas in 19 individuals. No false-negative results were encountered. In this study sensitivity of high-resolution computed tomography was 100%, and specificity was 86%. High-resolution computed tomography appears to be more helpful than previously reported for determining cochlear patency.

Acoustic Stimulation↗
PubMed1999

The cell as the smallest DNA-based molecular computer.

The pioneering work of Adleman (1994) demonstrated that DNA molecules in test tubes can be manipulated to perform a certain type of mathematical computation. This has stimulated a theoretical interest in the possibility of constructing DNA-based molecular computers. To gauge the practicality of realizing such microscopic computers, it was thought necessary to learn as much as possible from the biology of the living cell--presently the only known DNA-based molecular computer in existence. Here the recently developed theoretical model of the living cell (the Bhopalator) and its associated theories (e.g. cell language), principles, laws and concepts (e.g. conformons, IDS's) are briefly reviewed and summarized in the form of a set of five laws of 'molecular semiotics' (synonyms include 'microsemiotics', 'cellular semiotics', or 'cytosemiotics') the study of signs mediating measurement, computation, and communication on the cellular and molecular levels. Hopefully, these laws will find practical applications in designing DNA-based computing systems.

Animals↗
PubMed1997

Automated planning target volume generation: an evaluation pitting a computer-based tool against human experts.

PURPOSE: Software tools are seeing increased use in three-dimensional treatment planning. However, the development of these tools frequently omits careful evaluation before placing them in clinical use. This study demonstrates the application of a rigorous evaluation methodology using blinded peer review to an automated software tool that produces ICRU-50 planning target volumes (PTVs). METHODS AND MATERIALS: Seven physicians from three different institutions involved in three-dimensional treatment planning participated in the evaluation. Four physicians drew partial PTVs on nine test cases, consisting of four nasopharynx and five lung primaries. Using the same information provided to the human experts, the computer tool generated PTVs for comparison. The remaining three physicians, designated evaluators, individually reviewed the PTVs for acceptability. To exclude bias, the evaluators were blinded to the source (human or computer) of the PTVs they reviewed. Their scorings of the PTVs were statistically examined to determine if the computer tool performed as well as the human experts. RESULTS: The computer tool was as successful as the human experts in generating PTVs. Failures were primarily attributable to insufficient margins around the clinical target volume and to encroachment upon critical structures. In a qualitative analysis, the human and computer experts displayed similar types and distributions of errors. CONCLUSIONS: Rigorous evaluation of computer-based radiotherapy tools requires comparison to current practice and can reveal areas for improvement before the tool enters clinical practice.

Expert Systems↗
PubMed1984

Computer system for analysis of ST segment changes on 24 hour Holter monitor tapes: comparison with other available systems.

The accuracy of a computer system that was developed for the analysis of ST segment changes recorded on Holter ambulatory electrocardiographic monitoring tapes was compared with conventional visual scrutiny, beat by beat analog printouts and a commercial J point trend system. The program calculates and plots multiple electrocardiographically derived variables in a high temporal resolution trend format. Fifty tapes of good recording quality obtained from 19 patients (13 with chronic stable angina and 6 with variant angina) were assessed visually and with the computer system; of these, 20 were analyzed by all four techniques. In the 50 tapes, 629 episodes of diagnostic ST segment changes (all true positive results) were identified by using the computer system. In contrast, only 507 were identified by visual scrutiny; none of these 507 episodes was missed by computer analysis. On the 20 tapes assessed using computer, visual, beat by beat analog and J point trend system analysis, 268, 221, 230 and 178 episodes, respectively, were documented. For the four techniques, false negative and positive results were 0, 47, 38 and 90 and 0, 10, 6 and 24, respectively. The results indicate that, of the systems assessed in this study, the computer program provides the highest accuracy for detection of transient ST segment changes. This is probably accreditable to the compact presentation of multiple electrocardiographically derived variables, allowing a detailed quantitative assessment of 24 hour tapes. It is of particular value for pathophysiologic and pharmacologic studies.

Angina Pectoris↗
PubMed1986

Cardiology office computer use: primer, pointers, pitfalls.

An office computer is a utility, like an automobile, with benefits and costs that are both direct and hidden and potential for disaster. For the cardiologist or cardiovascular surgeon, the increasing power and decreasing costs of computer hardware and the availability of software make use of an office computer system an increasingly attractive possibility. Management of office business functions is common; handling and scientific analysis of practice medical information are less common. The cardiologist can also access national medical information systems for literature searches and for interactive further education. Selection and testing of programs and the entire computer system before purchase of computer hardware will reduce the chances of disappointment or serious problems. Personnel pretraining and planning for office information flow and medical information security are necessary. Some cardiologists design their own office systems, buy hardware and software as needed, write programs for themselves and carry out the implementation themselves. For most cardiologists, the better course will be to take advantage of the professional experience of expert advisors. This article provides a starting point from which the practicing cardiologist can approach considering, specifying or implementing an office computer system for business functions and for scientific analysis of practice results.

Cardiology↗
PubMed1997

The use of computers in cancer pain management.

OBJECTIVES: To provide an overview of the present use of computer technology in cancer pain management. DATA SOURCES: Review articles, research studies, and books pertaining to the use of computers in cancer pain management. CONCLUSIONS: The availability of computer resources for cancer pain and nursing are limited. However, the application of computer technology to cancer pain management has the potential to improve our delivery of care, educate both health care professionals and consumers, and improve outcome measures. IMPLICATIONS FOR NURSING PRACTICE: Computers can assist our efforts to improve quality of care, teaching, research, and communication with patients. It is essential for nurses to be knowledgeable about available computer resources and the application of new technology.

Computer Communication Networks↗
PubMed1992

[Automatic analysis by computer of the visual suppression test of pendular rotatory vestibular nystagmus].

This study presents an automatic computerized analysis of the visual suppression test of vestibular nystagmus. Visual suppression is measured during rotatory nystagmus examination. The amplitude variations and the frequency of the nystagmus are computed in the dark and in the light. This allows the computer to furnish with the help of an algorithm the percentage of nystagmus suppressed by ocular fixation. The results of the computerized analysis are compared to a qualitative evaluation. A percentage of 70% and more indicates a normal suppression reflex and corresponds qualitatively to a total or subtotal visual suppression. A percentage smaller than 70% indicates a pathological reflex corresponding qualitatively to a partial, weak or absent visual suppression. The study is based on 149 examinations realised in 12 healthy subjects and 137 patients. The patients are classified into 4 groups: a) 59 patients with peripheral vestibular lesions (Ménière's diseases 21, vestibular neuronitis 15, cupulolithiasis 16, ototoxicity 7), b) 67 patients with central lesions of the cerebellum and the brainstem (multiple sclerosis 23, infratentorial tumors 14, vascular brainstem lesions 14, degenerative diseases of the central nervous system 16), c) 6 patients with supratentorial central lesions (hemispheric vascular lesions 4, supratentorial tumors 2), d) 5 patients with congenital nystagmus. All healthy subjects and all patients with peripheral vestibular lesions have a total or subtotal visual suppression corresponding to computed rates greater than 70% (mean: 86.7% and 83.1%). In cerebellar and brainstem lesions about half the patients (56.8%) present a partial, weak or absent visual suppression corresponding to computed rates inferior to 70% (mean: 52.7%). In supratentorial disorders the visual suppression is total or subtotal with computed rates superior to 70% (mean: 79.2%). By patients with congenital nystagmus the visual suppression is uniformly pathological with computed rates inferior to 70% (mean: 19.2%). The results of the visual suppression test are concordant with those of smooth pursuit in 92.6% of cases and with those of optokinetic nystagmus in 89.3% of cases. This study confirms that the visual suppression test is a useful examination to detect disorders of the cerebellum and brainstem.

Adolescent↗
PubMed1996

Use of computer conferencing to allow view box-style teaching sessions with residents at outlying hospitals.

RATIONALE AND OBJECTIVES: Health care reform is placing new pressures on radiology faculty members to use their time more efficiently. We implemented a computer conferencing technique that allows one faculty member to perform a simultaneous view box-style teaching session with residents at local and outlying hospitals. METHODS: The system simultaneously displays digital images on computer screens at the local and outlying hospitals; an on-screen pen allows the instructor or the participants to point to findings on the images. Audio is provided either by a telephone conference call using speakerphones or over the wide-area network using microphones and speakers built into the computers. RESULTS: The technique has been in use for 1 year. A survey of the faculty and residents indicate that computer conferencing is equivalent to traditional face-to-face teaching sessions at the view box. CONCLUSION: Computer conferencing is possible and accepted. The technique is low-cost, using generic computers that are part of the picture archiving and communication system at both hospitals, and relatively inexpensive conferencing software.

Computer Communication Networks↗
PubMed1999

Detectability of anterior displacement of the articular disk in the temporomandibular joint on helical computed tomography: the value of open mouth position.

OBJECTIVE: The purpose of this study was to establish the diagnostic reliability of anterior displacement of the articular disk in the temporomandibular joint on helical computed tomography. STUDY DESIGN: Ninety-four consecutive patients were examined through use of both computed tomography and magnetic resonance imaging. On axial computed tomography, anterior disk displacement was defined as the presence of an area of soft tissue density that was semilunar in shape and located in front of the mandibular condyle. RESULTS: With magnetic resonance imaging taken as the diagnostic gold standard in evaluation of articular disk position, the sensitivity, specificity, and accuracy for computed tomography were 91%, 100%, and 97%, respectively, in the closed mouth position and 96%, 99%, and 98%, respectively, in the open mouth position. CONCLUSIONS: The detectability on axial helical computed tomography of anterior displacement of the articular disk in the temporomandibular joint in the open mouth position was almost equal to that on magnetic resonance imaging. It is recommended that the open mouth position be added when helical computed tomography is used to evaluate patients with temporomandibular joint disease.

Absorptiometry, Photon↗
PubMed1998

Computers in the consulting room: a case study of clinician and patient perspectives.

Few clinicians in the United States use computers during patient encounters and many still worry that computers will depersonalize their interactions with patients. This case study describes patient and clinician reactions to a computer-based health appraisal system. Findings showed no difference in any aspect of patient satisfaction between computer and non-computer groups. Use of a computer in the consulting room neither depersonalized nor enhanced patient satisfaction. Clinicians (in this case, nurse practitioners and physician assistants) were willing to use the system, which they perceived as having benefits for patient care, but were concerned about the increased time required for exams, effort required to learn the system while still interacting appropriately with the patient, increased monitoring of their performance, and other organizational issues. Clinicians who used the system showed a higher tolerance for uncertainty and communicated more frequently with each other and with others throughout the department. Implementation was slowed by the need to demonstrate the monetary value of the system.

Attitude of Health Personnel↗
PubMed2002

Computers in psychiatry: a review of past programs and an analysis of historical trends.

In a variety of clinical settings, computers are playing an increasing role in managing or retrieving clinical information. A recent survey of physician computer use suggests that psychiatrists, in comparison to other types of medical specialists, may be using computers less in routine care. In this paper, we present a literature review of 57 articles on computer programs in psychiatry that were published since 1966 in five major peer-reviewed journals. We divide the types of programs that have been developed into four categories: (1) diagnostic and decision support, (2) patient screening and therapy, (3) data collection and management, and (4) data modeling. Among the first three categories, we found trends in publications during the past three decades of research. We provide a discussion of representative computer programs. Our analysis of past programs reveals a number of design problems that may be a barrier to the more widespread use of computers in psychiatry.

Computers↗
PubMed2001

Computer control versus manual control of systemic hypertension during cardiac surgery.

BACKGROUND: We recently demonstrated the feasibility of computer controlled infusion of vasoactive drugs for the control of systemic hypertension during cardiac surgery. The objective of the current study was to investigate the effects of computer controlled blood pressures on hemodynamic stability when compared to conventional manual control. METHOD: Systemic artery blood pressures were managed either by computer (80 patients) or by a well-trained anesthesiologist (80 patients). The vasodilator drugs sodium nitroprusside and nitroglycerin were used. Hemodynamic stability was determined from the standard deviation of the mean arterial pressure samples and from the percentages of time that arterial pressure was hypertensive or hypotensive. RESULTS: The average standard deviation of the mean arterial pressure samples was smaller for the computer controlled than for the manually controlled group: 7.5+/-2.2 (mean+/-SD) versus 8.9+/-2.3 mmHg (P<0.0001). The systemic artery pressure was less hypertensive and less hypotensive in the computer controlled than in the manually controlled group: 9.4+/-5.7 versus 13.1+/-6.0% (P<0.0001) and 8.0+/-5.9 versus 11.8+/-7.4% (P<0.0001), respectively. CONCLUSION: We conclude that, compared with manual control, computer control of systemic hypertension significantly improved hemodynamic stability during cardiac surgery.

Adult↗
PubMed2001

Sociopsychiatric characteristics of adolescents who use computers to excess.

OBJECTIVE: This study attempted to investigate current computer use by Korean adolescents, consequences of its excessive use and its relationship to psychiatric symptoms. METHOD: Questions for computer use, Computer-Related Addictive Behavior Inventory (CRABI), computer-induced behavioral alterations and Symptom Checklist-90-Revision (SCL-90-R) were assessed in 1296 students (12-19 years). RESULTS: Students were divided into three group users: minimal users (63.4%), moderate users (30.5%) and excessive users (6.1%). Computer-induced behavioral alterations occurred most frequently to excessive users and it was significantly correlated with total CRABI score. Average score on nine symptom dimensions and three global indexes of SCL-90-R were able to discriminate four decreasing orders of subjective psychiatric complaints: most frequent in excessive users and then moderate, non- and mild users, in order. CONCLUSION: Those adolescents with excessive computer use were found to show serious sociopsychiatric problems.

Adolescent↗
PubMed2000

DNA computing on surfaces.

DNA computing was proposed as a means of solving a class of intractable computational problems in which the computing time can grow exponentially with problem size (the 'NP-complete' or non-deterministic polynomial time complete problems). The principle of the technique has been demonstrated experimentally for a simple example of the hamiltonian path problem (in this case, finding an airline flight path between several cities, such that each city is visited only once). DNA computational approaches to the solution of other problems have also been investigated. One technique involves the immobilization and manipulation of combinatorial mixtures of DNA on a support. A set of DNA molecules encoding all candidate solutions to the computational problem of interest is synthesized and attached to the surface. Successive cycles of hybridization operations and exonuclease digestion are used to identify and eliminate those members of the set that are not solutions. Upon completion of all the multistep cycles, the solution to the computational problem is identified using a polymerase chain reaction to amplify the remaining molecules, which are then hybridized to an addressed array. The advantages of this approach are its scalability and potential to be automated (the use of solid-phase formats simplifies the complex repetitive chemical processes, as has been demonstrated in DNA and protein synthesis). Here we report the use of this method to solve a NP-complete problem. We consider a small example of the satisfiability problem (SAT), in which the values of a set of boolean variables satisfying certain logical constraints are determined.

Computing Methodologies↗
PubMed1982

Evaluation of a computer-assisted method for individualized anticoagulation: retrospective and prospective studies with a pharmacodynamic model.

We studied the effectiveness of a computer program based on a mathematic model of warfarin dynamics in assisting with the initial phases of anticoagulation. In retrospective evaluations the program was successful in predicting prothrombin complex activity (PCA) responses for three different groups of subjects, indicating that the model is a good representation of the physiologic system. In a prospective evaluation of the program a computer-assisted group of 10 patients was compared with a control of 10 patients who did not receive computer assistance. Because of the program's very conservative upper limits for warfarin dosage in the first few days of therapy, the computer-assisted patient require slightly more time (6 days), on the average, to first reach PCA values in the 20% to 30% therapeutic range than did the control patients (4.8 days). After the desired PCA had been achieved, however, the computer-assisted group remained within the therapeutic range for 83% of the time compared to only 60% for the control group. This difference was due primarily to much less overanticoagulation of the computer-assisted patients than of the controls.

Blood Coagulation↗