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PubMed1979

The CASE system for cancer education.

A Computer-Assisted-Self-Evaluation (CASE) program in oncology is described. The program is based on motivation by immediate, informative feedback, and involves the computer-guided interaction of a student with a series of microfiche cards. The computer leads the student through a series of 16 questions and associated explanations and recommendations based on the answer choices. Since all textual materials are placed on microfiche cards, the computer is only required to print simple, prearranged sentences and comments. As a result four students, using different CASE topics, can time-share the same computer terminal. This time-sharing capability, together with the large but compact, low cost information storage afforded by the use of microfiche, makes the cost of this system comparable to that of conventional study aids. The use of the CASE system as an educational aid and self-tutoring mechanism has been well accepted by faculty and students.

Attitude↗
PubMed1989

Development of a computerized laboratory alerting system.

Using the capabilities of the HELP medical information system at LDS Hospital, a Computerized Laboratory Alerting System (CLAS) was developed. CLAS monitors and alerts for the presence of life-threatening conditions in hospitalized patients which are indicated by laboratory test results. Alerts are posted on computer terminals on the hospital's nursing divisions, where they are reviewed and acknowledged by hospital staff so that appropriate treatment can be rapidly instituted. CLAS was evaluated to determine its effectiveness in relaying alerts to the clinical staff, and improvements were made to develop an effective user interface. Initial average alert response times on nursing divisions ranged from 5.1 to 58.2 hr. The average alert response time dropped to 3.6 hr when alert review was integrated with laboratory result review, and to 0.1 hr after installation of a flashing light to notify hospital staff of the presence of new alerts.

Clinical Laboratory Information Systems↗
PubMed1975

A quantitative comparison of traditional reading of the EEG and interpretation of computer-extracted features in patients with supratentorial brain lesions.

The EEGs of adult patients with suspected supratentorial brain lesions were recorded on paper and on magnetic tape, using a small computer. The spectra of 16 channels were computed on a 40 sec sample. For each channel, a ratio of the type (delta + theta)/(alpha + beta) was computed and displayed on the computer terminal, a measure of the asymmetry in slow wave activity between homologous areas of the head was also displayed. This display is called a canonogram. It is believed to be a meaningful representation of the important characteristics of the EEG in the presence of supratentorial lesions. In order to assess the clinical value of the canonogram, the presumed localization of the lesion obtained from the interpretation of the traditional EEG and from that of the canonogram were compared to the known location of the lesion is a group of 87 subjects. The comparison was made quantitative by the use of a structured report encoding the traditional interpretation and that of the canonogram as well as the reference data (unequivocal surgical, radiological and clinical localizing evidence). The results varied among the anatomical regions: whereas in the frontal and occipital regions the EEG was slightly more accurate than the canonogram, both methods were similar in the temporal areas and the canonogram seemed more accurate in the centro-parietal regions. An attempt was made to interpret these differences. Furthermore, three readers read the cononograms and gave very consistent interpretations. These results show the reliability and value of this simple computer display for the particular type of EEG studied.

Adult↗
PubMed1979

Development of ocularity domains and growth behaviour of axon terminals.

Ontogenetic development of ocularity domains--stripes, patches and layers in cortex, colliculus superior and lateral geniculate nucleus--is the result of organization that may either be intrinsic to the postsynaptic structure or induced to it by the afferents. A specific type of axonal growth behaviour that was recently proposed as a basis for ontogenetic development of retinotopy is sufficient to account also for ocularity domains. No intrinsic organization in the postsynaptic structure is required. The latter merely serves as a propagating medium for markers carried by the presynaptic terminals. Computer simulations demonstrate the mechanism to be complete and consistent.

Animals↗
PubMed1989

Computerized nurse charting.

Computerized nurse charting programs have been used at LDS Hospital for over two years. These programs allow the nurse to create nurse care plans for the management of the patient, and chart on the computer actions and information which support the documentation of the management of the patient according to the care plan created for the patient. Computer terminals have been placed at the patient's bedside to facilitate the use of these programs. This paper describes the programs available at LDS Hospital and several evaluation studies which have been performed to measure the efficacy of the programs. The evaluation studies indicated an increase in the level of documentation completeness and accuracy by the nurse but at some minor expense to time available to the nurse for patient care. Evaluation of the need for bedside terminals versus centrally located terminals showed an overwhelming desire by the nurse in favor of the bedside terminal. It was also found that data was entered more timely with less waiting when bedside terminals were available. Physician acceptance of the nurse charting system was found to be favorable.

Humans↗
PubMedDate not supplied

A strategy for development of computerized critical care decision support systems.

It is not enough to merely manage medical information. It is difficult to justify the cost of hospital information systems (HIS) or intensive care unit (ICU) patient data management systems (PDMS) on this basis alone. The real benefit of an integrated HIS or PDMS is in decision support. Although there are a variety of HIS and ICU PDMS systems available there are few that provide ICU decision support. The HELP system at the LDS Hospital is an example of a HIS which provides decision support on many different levels. In the ICU there are decision support tools for antibiotic therapy, nutritional management, and management of mechanical ventilation. Computer protocols for the management of mechanical ventilation (respiratory evaluation, ventilation, oxygenation, weaning and extubation) in patients with adult respiratory distress syndrome ((ARDS) have already been developed and clinically validated at the LDS Hospital. These protocols utilize the bedside intensive care unit (ICU) computer terminal to prompt the clinical care team with therapeutic and diagnostic suggestions. The protocols (in paper flow diagram and computerized form) have been used for over 40,000 hours in more than 125 adult respiratory distress syndrome (ARDS) patients. The protocols controlled care for 94% of the time. The remainder of the time patient care was not protocol controlled was a result of the patient being in states not covered by current protocol logic (e.g. hemodynamic instability, or transport for X-Ray studies). 52 of these ARDS patients met extra corporal membrane oxygenation (ECMO) criteria. The survival of the ECMO criteria ARDS patients was 41%, four times that expected (9%) from historical data (p less than 0.0002).(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1985

[On the way to a Swiss microcensus].

In order to avoid some of the problems connected with the census of the population and with the intention of actualizing the latter and providing the Federal administration as a whole with a rational means to obtain the necessary information on living conditions in the country, the Swiss Federal Statistical Office is planning to introduce annual sample surveys. It has spent a two years experimental stage working out contents and solutions to methodical and organizational problems. The planned household survey will consist of two parts, a general programme with demographic and socioeconomic variables and a specific programme. Two sample sizes will be used to get representative national or cantonal results. Written and/or oral survey methods will be chosen in accordance with the subject; telephone interviews with the help of a computer terminal will be one of the favourite methods. Participation will be optional. Before the end of this year, the Government will decide whether this statistical instrument is to be adopted.

Humans↗
PubMed1986

Adapting disease-specific isolation guidelines to a hospital information system.

The authors modified the Centers for Disease Control's guideline for disease-specific isolation precautions to a hospital computerized information system. Entering a suspected diagnosis selected from the isolation option on computer terminals generated: a printout listing the isolation instructions, infective material(s), and persons who should avoid exposure; an order for the appropriate supplies; a patient charge based on the supplies required; and an option for stopping, changing, or listing the orders. In order to implement this system, both extensive in-service training for nurses and efforts to change ordering practices of physicians were necessary. Prevalence surveys before and after computerization were used to evaluate the new system. Combined surveys showed that isolation was ordered for only 21% of patients when indicated. Failure to isolate was identified as a significant problem. As a consequence, continuous surveillance and consultation of all infected patients were instituted, resulting in isolation orders for 81% when indicated. The computerized disease-specific system has resulted in better and more accurate use of isolation, probably due to in-service education and surveillance efforts.

Centers for Disease Control and Prevention, U.S.↗
PubMed1992

Future-event schemas and certainty about the future: automaticity in depressives' future-event predictions.

The proposition was tested that depressives make predictions about the future based on a pessimistic future-event schema. Participants varying in depression predicted whether positive and negative events would happen to them (or to an average person) in the future by pressing yes or no at a computer terminal as quickly as possible, either under a concurrent attentional load or under no such load. As hypothesized, depressives predicted more negative events and fewer positive events than did mild depressives or nondepressives and showed greater automaticity in their predictions. That is, the attentional load did not increase depressives' response latencies for either negative or positive events, even though it did so reliably for both mildly depressed and nondepressed individuals. Depressives may thus possess a highly developed future-event schema that operates efficiently in enabling future-event predictions.

Adult↗
PubMed1990

A total audit of preventive procedures in 45 practices caring for 430,000 patients.

OBJECTIVE: To develop and report the results of a system of audit of computer records in general practice. DESIGN: A retrospective audit of records in practices using the same computer system. Information about recorded preventive procedures was collected by sending the same audit program to each practice on floppy disk. Other characteristics of the practices were determined by postal questionnaire. SETTING: Forty five general practices, widely distributed in England and Wales. SUBJECTS: All 430,901 patients registered with the practices. MAIN OUTCOME MEASURES: Within each practice the percentage of patients in specified age groups for whom certain preventive procedures were recorded as having been carried out. These measures were analysed in relation to practice characteristics. RESULTS: Practice characteristics and recording rates for preventive procedures varied over a wide range. Recording rates were higher in practices with computer terminals on every doctor's desk. Only one practice achieved the new contract target of 90% coverage for recorded primary immunisations, and fewer than two thirds recorded 80% coverage for cervical cytology in the past five years. Practices holding clinics did no better than those without. Smaller partnerships and smaller doctors' list sizes were associated with better performance. CONCLUSIONS: Centrally programmed audit of computerised records is a feasible method of providing data on a regular basis for epidemiological purposes and for performance review. The fact that practices with smaller list sizes had higher levels of recorded preventive care suggests that the trend towards larger lists promoted by the new contract might militate against the intended effect of better preventive care.

Adolescent↗
PubMed1989

Sustained maximal ventilation after endurance exercise in athletes.

Although impaired respiratory muscle performance that persists up to 5 min after exercise is stopped has been demonstrated during exhaustive exercise in normal young men, it is not known whether impaired respiratory muscle function follows endurance exercise to exhaustion in highly trained athletes. To study the effects of exercise on sustained maximal voluntary ventilation immediately after exercise, eight elite cross-country skiers performed a 4-min maximal sustained ventilation (MSV) test before and immediately after exhaustive exercise. Subjects were encouraged to maintain maximal ventilation (VE) throughout the MSV test. To encourage greater effort, rapid visual feedback of VE was provided on a computer terminal along with a target VE based on their 12-s maximum voluntary ventilation (MVV). The subjects (7 males, 1 female) were 18.5 +/- 0.9 yr old (mean +/- SD) and exercised for 62.5 +/- 16.7 min at 77 +/- 5% of their maximum oxygen consumption during which average VE was 106.7 +/- 24.2 l/min BTPS. The mean MVV was 196.0 +/- 29.9 l/min or 107% of their age- and height-predicted MVV. Before exercise the MSV was 86% of the MVV or 176.7 +/- 30.5 l/min, whereas after exercise the MSV was 90% of the MVV or 180.3 +/- 28.9 l/min (P = NS). The total volume of gas expired during the 4-min MSV was 706.7 +/- 121.9 liters before and 721.2 +/- 115.5 liters after exercise (P = NS). In this group of athletes, exhaustive exercise produced no deleterious effects on the ability to perform a 4-min MSV test immediately after exercise.

Adolescent↗
PubMed1985

Eliciting preferences for alternative cancer drug treatments. The influence of framing, medium, and rater variables.

In oncology there is increasing interest in the development of techniques to help patients choose between alternative therapies in ways that are consistent with their preferences. The purpose of this study was to examine some methodological problems associated with the elicitation of preferences. Preferences for alternative drug therapies were sought from 208 visitors to an open house at the Ontario Cancer Institute and from 216 university nursing students. Preferences were not significantly dependent on the sex, age or professional status of the respondents, nor on the medium used for elicitation of preferences (computer terminal versus pencil-and-paper questionnaire). In contrast, the importance of the way decision problems are framed was confirmed. Comparison of a positive frame (outcomes expressed as the probability of surviving) with a negative frame (outcomes expressed as the probability of dying) and a mixed frame (probabilities of surviving and dying were both given) pointed to the presence or absence of the word "survive" in the outcome description as the main source of framing bias. The framing effect was in the opposite direction to that hypothesized.

Adolescent↗
PubMed1988

An evaluation of labeling-then-doing with moderately handicapped persons: acquisition and generalization with complex tasks.

We conducted two experiments in which moderately mentally retarded persons were trained first to label and then to enter characters into a computer, calculator, or checkbook (label-then-do) within a multiple baseline design. In Experiment 1, 5 young adults were trained to enter statistical programs into computers in an office setting. Following training, all subjects' use of verbal labels and key-entry skills generalized across tasks (programs) and settings (offices and computer terminals). In Experiment 2, 3 junior high school students were trained with self-labeling procedures to complete a key-entry task and to balance a checkbook. The performance of all students generalized across tasks and settings, and the use of labels generalized for 2 of the students. Results are discussed relative to mediated generalization and to establishing verbal control over behavior.

Adolescent↗
PubMed1987

Controlling relations in conditional discrimination and matching by exclusion.

Normally capable adults learned two-choice identity matching of three-digit numerals and arbitrary matching of physically dissimilar nonsense syllables. The stimuli were displayed on a computer terminal, and responses consisted of typing on the terminal's keyboard. In Experiment 1, every trial displayed a sample numeral, a comparison numeral, and three equal signs (= = =). The comparison stimulus was to be selected if it was identical with the sample; otherwise the equal sign was to be selected. This "single comparison" method was then used to show that arbitrary matching could be based upon either sample-S+ or sample-S- relations. In Experiment 2, a series of probe trials displayed a novel sample, a comparison stimulus from the arbitrary matching baseline, and = = =. Subjects typically selected = = =; they apparently were excluding the baseline comparison stimulus. Experiments 3 through 5 investigated which variables in training would lead to the selection of baseline comparison stimuli in response to novel samples. Behavior was usually unchanged when baseline training included relating comparison stimuli to as many as four different samples. Punishment contingencies were effective, but performance did not generalize unless those contingencies were applied in relation to more than one baseline comparison stimulus.

Cues↗
PubMed1991

Computerized clinic scheduling system at the University of Michigan Medical Center.

The University of Michigan Medical Center has a flexible computerized clinic scheduling system that handles approximately 750,000 visits per year at the main hospital and satellite locations. The system includes a wide variety of fully integrated functions, including appointment booking, multiple and series scheduling, wait and reschedule lists, routine reminder notices, routine requests for medical records and radiology reports, no-show follow-up, and managerial reporting at multiple levels of detail. The system is extremely flexible, and allows separate scheduling specifications for every physician and all other resources within the system. The system is available at any of the approximately 1,800 computer terminals throughout the Medical Center, and is regularly used at approximately 400 terminals.

Academic Medical Centers↗
PubMed1991

[The effect of training with computer equipment on the visual analyzer of 1st-grade pupils].

Examination are carried out on 64 school children Ist class from school "104", town of Sofia where computer training on mathematics and mother tongue is introduced in the frames of pedagogic experiment. The studies are performed parallelly at traditional and computer lessons, realized in two variants (with one and two school hours daily). In order to establish the functional status of the visual analyzer during computer training the following methods are used: studying the distance of the nearest point for clear vision (punctum proximum), stability of clear vision, threshold of the electric eye sensitivity, critical frequency of fusing of the light flickerings. A full preliminary ophthalmological examination is made by "Vision test", as well as chronometric control of each student to establish the real time of work with computers. Taken into consideration are also the data for illumination of the working places in the computer studies and class rooms where the traditional school hours are held. The analysis of the data received shows that the computer training (1 and 2 computer lessons daily) with schoolchildren, Ist class, has no unfavourable effect on the functional status of the visual analyzer in the limits of study hours up to 25 minutes.

Accommodation, Ocular↗