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PubMed2004

Computer-aided tissue engineering: overview, scope and challenges.

Advances in computer-aided technology and its application with biology, engineering and information science to tissue engineering have evolved a new field of computer-aided tissue engineering (CATE). This emerging field encompasses computer-aided design (CAD), image processing, manufacturing and solid free-form fabrication (SFF) for modelling, designing, simulation and manufacturing of biological tissue and organ substitutes. The present Review describes some salient advances in this field, particularly in computer-aided tissue modeling, computer-aided tissue informatics and computer-aided tissue scaffold design and fabrication. Methodologies of development of CATE modelling from high-resolution non-invasive imaging and image-based three-dimensional reconstruction, and various reconstructive techniques for CAD-based tissue modelling generation will be described. The latest development in SFF to tissue engineering and a framework of bio-blueprint modelling for three-dimensional cell and organ printing will also be introduced.

Animals↗
PubMed2002

Body computed tomography in critically ill patients.

The aim of the study was to assess the effectiveness of computed tomography in the management of critically ill patients. We performed a prospective study over a 4-month period. The requesting clinician was asked to document their clinical diagnosis and confidence thereof on a visual analogue scale. They were also asked about their management plan if computed tomography had not been available. After imaging, any change in the management plan was assessed. During the study period, 16 computed tomograms were performed on 14 patients. There were 21 possible clinical diagnoses: of these eight were confirmed, and 13 were refuted. Seven new diagnoses were established. Computed tomography did not help in the management of two patients and it led to more confusion in the management of one patient. The management of seven patients was altered after computed tomography and in six the management depended solely on computed tomography findings.

Confidence Intervals↗
PubMed1998

Computers in midwifery practice: a view from the labour ward.

Concern continues to exist about the lack of integration of research into clinical practice. One of the reasons which has been suggested for this, is that practitioners may either not know about, or understand, the research findings. The availability of a database which contains systematic reviews of research such as the Cochrane Pregnancy and Childbirth Database, should go some way to overcome such obstacles associated with the implementation of research into practice. As part of a national audit on Caesarean section, a computer with the Cochrane Database was installed in the labour ward of each consultant maternity unit in Scotland. The purpose of this study was to determine if midwives working in labour wards make use of this accessible source of research findings to inform their practice. Anecdotal evidence suggested that although midwives were keen to use the databases, they did not have the requisite computer skills to do so. This study examined the computer literacy of midwives and their perceived educational needs. A questionnaire was distributed to all labour ward midwives in 22 consultant maternity hospitals in Scotland (n = 850). This questionnaire considered issues such as the preparation of midwives to use computers, midwives' perceptions and use of computers and their perceived educational needs. The response rate was 74%. Following analysis of the questionnaire labour ward managers were interviewed by telephone to ascertain their views regarding the Cochrane Database and their perception of its effectiveness. The results highlighted that only 27% of midwives claimed to use the Cochrane Database on a regular basis. Overall midwives had a positive attitude towards information technology but claimed they did not have the requisite computer skills to use these tools. Managers agreed that there was a need for further instruction and support for midwives. The findings of this study have important implications for the future professional preparation and continuing education of midwives.

Adult↗
PubMed1999

Computer-aided learning: an overvalued educational resource?

AIM: The aim of this study was to evaluate the place of computer-aided learning in a basic science course in the undergraduate medical curriculum at the University of Adelaide. METHODS: A software program was written which would allow students to study the anatomy and physiology of the liver and biliary tree in three different styles. Identical content was produced, matched for each style (problem-based, didactic and free text response) and students randomly allocated to one of four groups (three computer and one control). Students were tested before and after access to the program. RESULTS: Ninety second-year students completed the study. Those students who had access to the material in the problem-based and free text response styles did no better in the post-study test than the controls, whilst the group who had studied the didactically presented computer material performed significantly better than the other three groups. All three computer groups accessed the material on a similar number of occasions, but the group who had access to the free text entry program spent significantly less time on computer study. CONCLUSIONS: If computer materials are to be provided as a learning resource for the basic medical sciences, provision must be made for the style of teaching of the course and the style of learning of the students attending that course.

Computer-Assisted Instruction↗
PubMed2001

Computer analysis of prolonged lower oesophageal sphincter pressure recordings.

The aim of the study was to validate a recently developed computer program for the analysis of prolonged recordings of lower oesophageal sphincter pressure. Thirty 1-hour stretches were selected from sets of 24-h pressure signals recorded from the pharynx, oesophagus, lower oesophageal sphincter (LOS) and stomach in 10 ambulant patients with gastrooesophageal reflux disease. Three experienced investigators visually analysed end-expiratory LOS pressures and transient lower oesophageal sphincter relaxations (TLOSRs), using published criteria. A computer program was developed for calculation of an end-expiratory pressure curve and detection of TLOSRs using the same criteria. Although the results showed an maximum deviation from the mean of 11.1% and 14.8% for manually calculated LOS pressures and visually detected TLOSRs, respectively only 62.1% of the detected TLOSRs were detected by all three observers. LOS pressure as measured by the computer closely approximated the mean of the LOS pressures calculated by the three observers. Although the total number of TLOSRs was comparable to that assessed by visual analysis, the computer detected only 46% of the TLOSRs detected by each observer and 56.8% of the TLOSRs detected by all observers. It is concluded that automated calculation of end-expiratory LOS pressure is feasible and yields reliable results, whereas automated detection of TLOSRs could not be satisfactorily accomplished. Our study showed that improvement of computer algorithms for TLOSR detection is desirable. However, the previously described criteria for detection of TLOSRs are insufficiently precise; further refinement of these criteria will be necessary to reduce the large discrepancies between the outcome of detection of TLOSRs by computer and by humans, and to reduce the equally large discrepancies between the results of detection by different human observers.

Adult↗
PubMed2001

A randomized trial comparing the effectiveness and preference of a touch-screen computer system with a leaflet for providing women with information on urinary symptoms suggestive of detrusor instability.

OBJECTIVES: To evaluate how well women learned and retained information given to them by either a leaflet or a computer-generated information system, and which system they preferred to use for obtaining information about urinary symptoms. SUBJECTS AND METHODS: Forty women answered 11 questions on the aetiology, investigation and treatment of lower urinary tract symptoms. They were then randomized to use one of the information systems for 20 min, after which they answered the same urological questions. The women then crossed over to use the other information system for 20 min and afterwards completed a preference questionnaire. RESULTS: The mean baseline scores from a possible total of 11 were 3.9 and 4.3 for the computer and leaflet groups, respectively. The mean improvements in scores were 3.6 (P < 0.001) and 2.8 (P < 0.001) for the computer and leaflet groups, respectively. Both information systems were well liked by all of the women and 26 (65%) said they would prefer to use a computer-generated system in the future if given a choice. CONCLUSIONS: Women significantly increased their knowledge of urinary problems after using a computer-generated information system or a leaflet. Although there were few subjects, there appeared to be a trend for the computer system to be both better liked and slightly more effective.

Adult↗
PubMed2002

Factors influencing the use of computer technology in the collection of clinical data in a predominantly African-American population.

OBJECTIVES: To determine the cognitive and demographic factors that affect the performance of a predominantly African-American population in the use of a computerized version of the Center for Epidemiologic Studies Depression Scale (CES-D). DESIGN: Cross-sectional. SETTING: University Medical Center and Veterans Affairs Medical Center in Baltimore, Maryland. PARTICIPANTS: Forty-three healthy community-dwelling adults from a predominantly African-American Apostolic church; mean age +/- standard deviation 57 +/- 14 (range 29-83). MEASUREMENTS: Cognitive measurements (Mini-Mental State Examination, digits span, word list learning, letter number sequencing, executive interview, and clock-drawing task), education level, computer experience, and age. The CES-D was administered on three occasions: a paper form CES-D once and a computerized version twice. Time to completion the computer CES-D (Time 1), differential in time to completion of both computer tests (delta-time) and scores of the CES-D with both forms of administration were recorded. RESULTS: There was no difference between the scores from the paper and the computer CES-D or between the two computer forms. Computer experience predicted Time 1 (partial correlation R = 15%, P =.017) and delta-time (partial correlation R = 10%, P =.048). Age, education, and cognitive function did not affect performance. CONCLUSION: Computerized assessment techniques are valid and unaffected by age, education level, or cognitive factors in healthy individuals.

Adult↗
PubMed2001

GPS computer navigators to shorten EMS response and transport times.

GPS (global positioning satellite system to determine one's position on earth) units have become inexpensive and compact. The purpose of this study is to assess the effectiveness of a GPS enhanced computer street map navigator to improve the ability of EMS drivers in an urban setting to locate their destination and shorten response times. For part I, residential addresses in the city were randomly selected from a telephone directory. Two driver/navigator teams were assigned to drive to the address adhering to speed limits. One team used a standard street map, whereas the other team used a GPS computer navigator. The travel time and distance of the runs were compared. For part II, the computer GPS navigator was placed on an ambulance to supplement their normal methods of navigation to find the address requesting EMS. After the run was completed, EMS providers were interviewed to determine their opinion of whether the GPS navigator was helpful. For part I the results showed that in the 29 initial test runs, comparing the GPS team versus the standard map team, the mean distances traveled were 8.7 versus 9.0 kilometers (not significant) and the mean travel times were 13.5 versus 14.6 minutes (P=.02), respectively. The GPS team arrived faster in 72% runs. For part II the results showed that most EMS providers surveyed noted that the GPS computer navigator enhanced their ability to find the destination and all EMS providers acknowledged that it would enhance their ability to find a destination in an area in which they were unfamiliar. These results suggest that a portable GPS computer navigator system is helpful and can enhance the ability of prehospital care providers to locate their destination. Because these units are accurate and inexpensive, GPS computer navigators may be a valuable tool in reducing pre-hospital transport times.

Ambulances↗
PubMed2001

Computer-assisted ECG interpretation for confirmation of premature atrial complexes.

UNLABELLED: Current programs for computerized ECG analysis are not interactive. We developed custom software for computer-assisted ECG interpretation that functioned interactively with an observer directing the computerized process. The software was first used for recognition of PACs superimposed on ST-T waveforms. The interactive process included 6 steps. 1) The computer displayed the 12-lead ECG and the user selected the most frequent QRS-T waveforms for averaging. 2) The computer generated and displayed the averaged QRS-T waveform. 3) The user selected waveforms suspected to have PACs superimposed on the ST-T segments. 4) The computer generated and displayed the difference waveform by subtracting the average waveform from the suspect waveforms. 5) The user recognized and p-waves in the difference waveform and marked the onset and offset by positioning the cursor and clicking. 6) The computer then measured p-wave amplitudes, durations, and areas and displayed the recognized p-wave. The program was developed using digital data from 2 ECGs and tested on 39 ECGs with suspected PACs and 26 control ECGs. RESULTS: The software and user interaction recognized 79 PACs in the suspect group. Control ECGs were analyzed using 3 complexes with the same leads and onsets as the test group. Of the 79 PACs found in the suspect group, mean values included an area under the curve of 4.0 +/- 3.2 microV-s for the test group versus 0.4 +/- 0.4 microV-s for the control (P < 0.001) and peak-to-trough voltage amplitudes of 104 +/- 66 microV versus 15 +/- 7 microV for the control (P < 0.001). The average time of onset of the premature complexes was 282 +/- 120 msec, and their duration was 100 +/- 28 msec. CONCLUSION: Custom software combined the superior human pattern recognition with the digital signal processing of the computer. This enhanced recognition of ectopic atrial activity.

Atrial Premature Complexes↗
PubMed2002

[Comparison of flat-panel radiography and computed radiography in urography].

PURPOSE: To evaluate the diagnostic value of digital flat-panel radiography in uroradiology the i. v. urograms of patients who had been examined with computed radiography and digital flat-panel radiography were compared regarding image quality. METHODS: 50 patients who underwent clinically indicated i. v. urography were examined with digital flat-panel radiography and computed radiography. In order to avoid unnecessary double exposure to X-rays, patients were examined either by flat-panel or computed radiography before injection of contrast media. Each further clinically indicated exposure after administration of contrast media was done by alternating the other examination technique. The digital images were compared by 4 radiologists regarding image quality for the detection of defined anatomic structures. RESULTS: Digital flat-panel radiography showed an image quality of the liver, spleen and both kidneys that was similar to computed radiography. The urinary tract, lumbar spine, pelvis and psoas muscle were significantly better visible on flat-panel radiography images. CONCLUSIONS: Compared to computed radiography there is no loss of image information by using digital flat-panel radiography in uroradiology. On the contrary, some anatomic structures on abdominal survey images show better image quality. In conclusion, digital flat-panel radiography has the potential to replace computed radiography in uroradiologic examinations.

Contrast Media↗
PubMed2006

[Questionnaire study on the acceptance of a student initiative for computer-based medical education].

BACKGROUND AND PURPOSE: Computer-based teaching and learning are getting more and more important in medical education. To integrate this type of training into the curricula, medical faculties must provide supervised computer labs. The present study was conducted to evaluate the acceptance and efficiency of the student-organised concept of computer labs established at the Charité Hospital in Berlin. METHODS: An electronic online questionnaire comprising 25 items was distributed to all users of the two computer labs at the Charité to ask their opinions about the quality of the student-organised concept and their satisfaction with the working conditions in the labs and to compare them longitudinally with the results obtained 4 years ago. RESULTS: A total of 1275 users worked in the labs during the survey period and 702 answered the questionnaire (return rate: 55.1%). The users assigned good to very good ratings to different components of the concept with student self-administration and helpfulness of the student tutors achieving the highest rating (both 1.5 +/- 0.7). In the longitudinal study no component of the concept was rated worse in the current questionnaire, whereas the opening hours were assigned significantly higher ratings than 4 years ago (1.6 +/- 0.8 vs. 2 +/- 0.9; p < 0.001). Over 20% of all users stated they would be interested in actively participating as tutors in the project. Students used the computer labs for a mean of 3.1 hours per week. The support of students working on a voluntary basis allowed for weekly opening hours of the labs of 146 hours with the personnel expenditure costs that would be necessary for the position of one faculty member. CONCLUSIONS: The good to excellent ratings, the high acceptance by users, and the low costs of the project presented here suggest that this student initiative can be recommended to other medical faculties to serve as a basis for integration of computer-based education into the curriculum.

Attitude↗
PubMed2001

The use of helical computed tomography in pregnancy for the diagnosis of acute appendicitis.

OBJECTIVE: Accurate diagnosis of acute appendicitis in pregnancy by clinical evaluation is difficult. A safe, reliable test was sought to decrease a delay in diagnosis and to avoid unnecessary invasive procedures. A helical or spiral computed tomographic technique has proven to be a very accurate test in the nonobstetric population for the identification of acute appendicitis. We report its use in pregnant patients with suspected acute appendicitis. STUDY DESIGN: All pregnant patients who were undergoing helical computed tomography at our institution from April 1997 to February 1998 for the suspected clinical diagnosis of acute appendicitis were retrospectively reviewed. Helical computed tomography was performed by standard departmental protocol. A positive study was reported if an enlarged appendix, which did not fill with contrast material, was present with periappendiceal inflammatory changes. Outcomes were determined by the results of surgery and pathologic examination or clinical follow-up. RESULTS: Seven patients were identified in the study period. Two patients had positive findings on helical computed tomography, and acute appendicitis was confirmed at laparotomy and by pathologic inspection. There were no further prenatal complications and both patients delivered at term. Five patients had a normal-appearing appendix on helical computed tomography, and all of these patients had resolution of their pain and symptoms. CONCLUSION: Helical computed tomography appears to be a useful, noninvasive test to accurately diagnose acute appendicitis in pregnancy.

Adult↗
PubMed2001

Detection of early-stage lung cancer: computed tomographic scan or chest radiograph?

OBJECTIVE: Computed tomography has recently been proposed as a useful method for the early detection of lung cancer. In this study we compared the stage distribution of lung cancers detected by a computed tomographic scan with that of lung cancers detected by a routine chest x-ray film. METHODS: Two groups of patients with biopsy-proven non-small cell lung cancer were reviewed. In the first group of 32 patients, the tumors were detected by a computed tomographic scan. In a second group (n = 101), the lung cancers were detected on routine chest x-ray films. Patients with pulmonary symptoms or a history of cancer were excluded. RESULTS: There was no difference in age, sex, or cell-type distribution between the 2 groups. A significantly greater number of patients undergoing a computed tomographic scan had stage IA disease compared with those having an x-ray film. Of the 32 patients in the group having a scan, 10 had tumors 1 cm or less in size versus 6 of 101 in the group having a chest radiograph. Additionally, there was a significant reduction in advanced stage disease in the group having a scan. CONCLUSIONS: In this retrospective study, a higher incidence of stage IA lung cancers and significantly fewer cases of more advanced disease were observed in patients screened with computed tomography than in those having a chest radiograph. These data suggest that computed tomographic screening may be of value in improving the survival of patients with non-small cell lung cancer.

Adult↗
PubMed1995

Computer mouse use and cumulative trauma disorders of the upper extremities.

The computer mouse is now present in virtually every office environment because of the recent adoption of the graphical user interface. However, Karlqvist et al. (1994) pointed out that there still remains a paucity of work on the musculoskeletal problems associated specifically with computer mouse use. Likewise, there have been no published data on the magnitude of upper extremity musculoskeletal disorders associated with computer mouse use. In order to ascertain this magnitude, claims data from the Liberty Mutual Group were reviewed for the years 1986 to 1993, inclusive. Count, total cost and average cost per claim for all claims associated with computer use and computer mouse use were determined for the years in question. It was concluded that although there are few claims related to computer mouse use, it appears to be a growing problem, and therefore, perhaps, deserves more research and intervention attention. However, the present magnitude is less than for other musculoskeletal disorders.

Arm↗
PubMed2003

The difference between playing games with and without the computer: a preliminary view.

The authors address the question of whether associations between video games and cognitive and metacognitive variables depend either on the features of the computer or on the content of the game that the computer allows one to play. An experiment to separate these two kinds of effects was carried out by using a traditional version and a computer-supported version of Pegopolis, a solitaire game. The two versions were exactly the same except that they were played by moving pieces either on a real board or on a virtual computer-presented board. The performance levels and strategies followed during the game by the 40 undergraduates who took part in the experiment were not significantly different in the real and virtual conditions. None of the participants transferred playing strategies or practice from one version of the game to the other. Scores were not affected by gender or by the studies pursued by participants, the habit of playing games in the traditional manner or playing video games, or intelligence. Retrospective reports did not support differences in the subjective experience between the two versions. Results showed that video games, when they do not make much use of the computer's special features, produce effects because of the situations they simulate rather than because of features of the computer itself.

Computers↗
PubMed2001

An evaluation of a computer-based psychiatric assessment: evidence for expanded use.

The purpose of this study was to examine the psychiatric diagnoses of depression made using the structured interview, the Computer-Based Diagnostic Inventory Schedule for Children-Revised (CDISC-R) and diagnoses of depression made by pediatric psychiatrists. One hundred and twenty-two adolescents who were admitted to an inpatient psychiatric treatment unit agreed to participate in the study. All participants completed the CDISC-R structured diagnostic interview and independent measures reflecting depressive symptoms. The admitting pediatric psychiatrists' diagnoses were also recorded. Even though there were more females in the sample, males (n = 38) and females (n = 84) had similar results. The computer-based CDISC-R and physician diagnoses agreed in 76% of the cases. These results were confirmed by the independent measures of depressive symptoms, which were higher for those with diagnoses of depression and lower for those without depression. In the 24% of the cases, where the CDISC-R and physician diagnoses disagreed, the computer-based CDISC-R was more accurate in assigning a diagnosis of depression in terms of the independent measures of depressive symptoms. The CDISC-R, a computer-based diagnostic interview, efficiently and precisely diagnoses depression. This finding indicates that the use of computer-based diagnostic interviews in applied research will provide more objective and precise results, especially in clinical trials. It follows from these findings that computer-based diagnostic interviews could have important clinical applications and play a central role in web-based mental health and Telemedicine by facilitating triage, referral, and monitoring treatment outcomes through remote electronic assessment.

Adolescent↗
PubMed1988

A computer-assisted diary (CAD) for ambulatory blood pressure monitoring.

Methods for logging activities during ambulatory blood pressure monitoring are time consuming and poorly standardized. To overcome these problems we have developed a computer-assisted diary (CAD). The subject marks boxes on a computer-readable card to indicate the time, location, body position, activity, and mood associated with each blood pressure reading. Software implemented on a personal computer downloads the diary information from a card reader, checks its quality, scores the data, extracts quantitative critical features, and inserts the information into computer files ready for data analysis and clinical report writing. The diary system was tested on 24-hour blood pressure scans of 32 normotensive working adults. The results indicated that the automated diary system was accepted well and used accurately by the subjects. Activities and moods coded by the CAD system were systematically related to the level of systolic blood pressure. The method produced results that are similar to those of traditional diaries, with major time and cost savings resulting from computer automation. We have concluded that the computer-assisted diary is an effective way to monitor behavioral states during ambulatory blood pressure monitoring which merits further trial applications.

Activities of Daily Living↗
PubMed1993

Skeletal muscle blood flow in heart failure measured by ultrafast computed tomography: validation by comparison with plethysmography.

OBJECTIVES: Abnormalities of skeletal muscle perfusion and metabolism may be important in the symptomatic limitation of patients with chronic heart failure. A method for assessing both skeletal muscle blood flow and mass would be useful in clinical practice and research. Ultrafast computed tomography has the potential to make these measurements. The aim was to determine the accuracy with which skeletal muscle blood flow could be measured by ultrafast computed tomography in patients with chronic heart failure. METHODS: Leg blood flow measured by venous occlusion plethysmography was compared with skeletal muscle blood flow by ultrafast computed tomography. Fourteen patients with chronic heart failure (aged 51 to 76 years) were investigated. Plethysmography and ultrafast computed tomography measurements were performed at rest and during hyperaemic flow induced by symptom limited bicycle exercise followed by five minutes of leg ischaemia. The ultrafast computed tomography measurements were made by analysing the opacification of the blood pool and of the muscle after an intravenous bolus of non-ionic radio-opaque contrast. RESULTS: Flows assessed by plethysmography ranged from 1.5 to 38.1 ml x 100 ml-1 x min-1. The slope of the line relating the two methods was 1.1 (95% confidence interval 0.91 to 1.31), and the mean (95% limits of agreement) of the differences between the two methods was 2.5(10.6) ml x 100 ml-1 x min-1. CONCLUSIONS: Ultrafast computed tomography is a useful tool in the measurement of both skeletal muscle mass and perfusion in humans.

Aged↗