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The role of dietitians in a work-site health promotion program.

Nutrition education has become an integral part of work-site health promotion programs. As more corporations, large and small, become involved in establishing their own programs, the need for qualified nutrition educators will increase. Registered dietitians should have a proactive role in this awareness process and should strive to develop specific skills in the areas of communications, management, and computer literacy. To succeed as nutrition educators at the work site, registered dietitians need to be able to wear many hats and to be organizers, planners, and innovative deliverers of nutrition information, as more and more U.S. corporations "reach out for health."

Dietary Services

End-user search behaviors and their relationship to search effectiveness.

One hundred sixty-one MEDLINE searches conducted by third-year medical students were analyzed and evaluated to determine which search moves were used, whether those individual moves were effective, and whether there was a relationship between specific search behaviors and the effectiveness of the search strategy as a whole. The typical search included fourteen search statements, used seven terms or "limit" commands, and resulted in the display of eleven citations. The most common moves were selection of a database, entering single-word terms and free-text term phrases, and combining sets of terms. Syntactic errors were also common. Overall, librarians judged the searches to be adequate, and students were quite satisfied with their own searches. However, librarians also identified many missed opportunities in the search strategies, including underutilization of the controlled vocabulary, subheadings, and synonyms for search concepts. No strong relationships were found between specific search behaviors and search effectiveness (as measured by the librarians' or students' evaluations). Implications of these findings for system design and user education are discussed.

Computer Literacy

Use of a multi-application computer workstation in a clinical setting.

The goal of this study was to assess the usage frequency, user satisfaction, and quality of literature searchers for a multi-application computer workstation in a university-based general medicine clinic. A computer with medical literature searching, textbook searching, and a decision-support program was deployed in the workroom of the clinic and made available for routine use. Data were collected for ten months. More than three quarters of the study participants used the computer, with use increasing by level of medical training. Despite physicians' known preferences for nonjournal sources of information, literature searching was the application used most frequently, followed by textbooks and decision support. The literature searches were replicated by experienced clinician and librarian searchers using first full MEDLINE and then text-word-only searching, to compare the quantities of relevant references retrieved. Novice searchers retrieved a larger number of relevant references than did the experienced searchers, but they also retrieved more nonrelevant references. For both groups of experienced searchers, the full MEDLINE feature set conferred little benefit over searching with only text words. These searching results call into question the value of traditional searching methods for both novice and experienced physicians.

Attitude to Computers

Computerized databases for emergency care: what impact on patient care?

A field-based evaluation is conducted of a Clinical Computerized Information System (CCIS). Following training, the use of the CCIS database, word processing and other programs by thirteen full-time practicing emergency physicians in two urban emergency departments of a University-associated teaching hospital was studied over a one-year period. A tracking program automatically logged frequency and duration of use by the physicians, and user satisfaction was assessed by a reliable and validated questionnaire instrument. Based on utilization data and verbal reports of these physicians, CCIS database searching was not only found to be easy-to-learn but was readily accessible during emergency shifts. Individual physicians were found to perform an average of 3.5 searches per month lasting a mean search time of 8 min. Positive notes about the CCIS system included ease-of-use, accuracy of data, accessibility of system, and value of output while negative perceptions included a lack of integration with other systems, a lack of system completeness, and a high subscription cost. It was suggested that a less costly telephone link to a high-volume Centre would be desirable in actual implementation of the system.

Attitude of Health Personnel

Databook: monitoring a critical care unit.

DataBook is a computer application developed to assist the nurse manager in collecting, assessing and monitoring unit data on a day-to-day and summary basis. Once captured, this information can then be presented to create "information snapshots" of unit characteristics. Utilizing a PC-based spreadsheet program, the application is designed to be used by individuals with a modest degree of computer literacy.

Critical Care

Supporting patient centered computing through an undergraduate nursing informatics curriculum stage III.

The patient has been one of the focal points of the process followed to design, implement, and evaluate an integrated informatics curriculum in a baccalaureate nursing program. This paper describes the third stage of a process to design the informatics nursing courses. A challenge is to structure the nursing informatics curriculum so as to enhance the patient care process. A number of strategies were used to focus the curriculum, students, and faculty around the patient. The basic components of the framework are information, technology, and clinical care process. The clinical care process which emphasizes the patient is an inherent part of the conceptual framework in all aspects of the curriculum. Therefore the faculty has ensured a blend of information, technology, and the clinical care process throughout the curriculum.

Computer Literacy

Implementing a local area network for nursing in a large teaching hospital.

The authors describe the assessment, planning, implementation, and benefits of a local area network (LAN) for the nursing service of a 504-bed urban teaching hospital. The major goals of the network were to increase the efficiency and effectiveness of the nursing administrative areas and improve communication systems. A network of more than 90 workstations, spanning 12 buildings, was installed. The network provides access to multiple programs that support clinical, managerial, and research activities. Gateways provide access to the hospital's two mainframe computers. Network benefits identified by nursing management include: improved communication and access to information; increased accuracy, efficiency and timeliness of data; and improved computer literacy.

Boston

[Electronic data processing in urologic clinics. Results of a survey. Electronic Data Processing in Urology Group of the Graduate and Continuing Education Commission of German Urologists].

Computer equipment in Departments of Urology in Germany was evaluated by a nation-wide questionnaire. One hundred and fifty-three questionnaires were returned with detailed information on computer hardware, software and applications in Urology. Most departments were equipped with at least one computer. Computer equipment varied considerably among the participants including both stand alone personal computers (PCs) and local area networks (LANs) with several PCs connected by cable. Typically, PCs were IBM-compatible and ran the MS-DOS operating system Word processing and related applications were the most frequently mentioned computer tasks in urology. In some departments computers are also used in research for production of databases and graphics and for statistical applications. When computers were used for documentation of therapy and/or medical records, software was often custom-made according to the department's specific needs. In the future, more computers will be needed in departments of urology, because medical records will have to meet higher standards of documentation.

Computer Literacy

Optimizing computer-based system use in health professions' education programs.

The use of computer-based systems to support training in health profession education programs has been discussed and analyzed for more than 10 years. The literature is rich with examples of how using these systems can benefit programs by more effectively distributing human resources, by making the delivery of instruction more individual and more flexible, by expanding the professional and technical competence of trainees, and by improving the monitoring of trainee performance. Obstacles to and conventional recommendations for the broadened use of computer-based systems are discussed, and an additional set of system design characteristics are described that health care educators can use in their preview and specifications for procurement of more effective computer-based systems in their training settings.

Attitude to Computers

Basics of computer hardware and software.

The basics of computer hardware and software are presented. A computer is a general-purpose electronic counting device used in data processing because of its accuracy and high speed. The physical components of a computer system are called the hardware, which includes the central processing unit and peripheral equipment for data input, output, and storage. Computer capacity is measured by the amount of data that can be stored in main memory and by the computer word size. Performance is indicated by the speed with which instructions are executed. Input devices (e.g., keyboard-type terminals) are the components that accept raw data and convert it into electronic form, and output devices (e.g., video display terminals) present the results of data processing in human-readable form. System software is the set of instructions that facilitate hardware use and allow the application software, which solves specific user problems, to run efficiently. System and application software is written by using various machine and symbolic languages. Milestones in software-development techniques include program subroutine use, modular programming, functional decomposition, structured programming, and structured analysis. Objectives in improving software quality are reducing development costs, making maintenance easier, and making development results more predictable. Because software development has lagged behind revolutionary advances in hardware, the full potential of computers has yet to be realized.

Computer Literacy

The role of the data manager in clinical cancer research. An opportunity for nurses.

A clinical trial is a research study conducted in humans and designed to answer specific questions using scientifically controlled methods. These trials require considerable effort to assure that the data obtained are reliable, reproducible, and readily available. Data managers play a key role in this research effort. A nurse with a clinical background, computer knowledge, and some experience in the research environment is well suited for the role of data manager. The data manager performs a variety of tasks in this position that will enhance the quality of the data gathered in a research study. These responsibilities include designing forms, monitoring protocol accrual, abstracting data, entering data onto protocol-specific forms and/or specifically designed computerized data-entry screens, assuring the quality and the integrity of the data, and providing investigators with interim and summary reports. In addition, the data manager can be responsible for the management of a computerized clinical data base system, including the training of users and the designing of basic reports for the investigators. A nurse, functioning as a data manager, who understands research methodology, is detail oriented, and is well organized, could be a valuable asset to the clinical trials team in the successful management of any clinical study.

Clinical Trials as Topic

Internet for teaching and learning introductory health informatics.

Internet resources seem attractive for teaching and learning. But are they usable and useful in their present form? We explored Internet, in particular its World Wide Web (WWW) resources, in a course on "Medical Methodology" (HINF270) for students of health information science. This course offers a systematic overview of the methodological principles of clinical care. Its broad scope and low depth makes this course a reasonable model to explore the limits of WWW resources. During the course, students wrote summaries of individual lectures. After critiquing and appropriate corrections, the texts were edited with Hypertext Mark-up Language (HTML) and augmented with links to WWW resources. Grading based on the papers, on their improvements through HTML and WWW, and on the provision of information on the search experience were incentives to use WWW. A formal questionnaire, administered on-line on a voluntary basis, concluded the investigation. Results show: 1) Even under considerable pressure to use WWW, libraries remain the reference source of choice for research; 2) Internet provides entertainment appeal even though practical utility is currently limited; 3) Technological proficiency with HTML and search engines is perceived as an asset; 4) Varying availability of Internet resources, uncertain and varying quality of sources, and limited specificity of research results are the major disadvantages of WWW. The teaching implications of these findings are discussed.

British Columbia