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Microcomputers are invading every aspect of life including the practice of pathology. This last in a series of articles is designed to help neophytes make effective use of these new tools. This article describes how microcomputers can be used in pathology and provides guidelines for deciding what processes are worth computerizing and for selecting software. No specific program is recommended.
Communication skills needed for the healthcare environment are changing. In the past, poor reading and writing skills made it difficult to use a paper chart. Current computer technology provides many new opportunities for communicating in the clinical setting. Computer literacy has become a necessary skill for efficient use of clinical computer systems. At this large tertiary care setting, a survey was developed and distributed to staff to assess learner needs. Nursing staff identified educational needs for basic computer knowledge, the ability to move between computer functions, and the skills to navigate through specific applications. Based on survey analysis, three educational classes were constructed that addressed the department's specific needs.
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Microcomputers could potentially represent the most exciting technological innovation in school health education. Both the technical capabilities and current constraints of microcomputer-based health education programs were reviewed. Based on this review the relatively economical, convenient, and educationally dynamic features of microcomputers were related to potential health education applications. However, current shortages in appropriate health education software limit the widespread utilization of microcomputers in the health education classroom. When microcomputer-based health education programs become more extensively available, the teaching of health can be revolutionized. Customized health education involving microcomputer-generated visual and auditory simulations and the dramatization of students' responses were envisioned. Furthermore, microcomputer-based health education programs that could be electronically transmitted to the 80% of American homes that will have microcomputers in 1990 will facilitate the provision of life-long and pervasive health education.
In medicine and biology there are many tasks that involve routine well defined procedures. These tasks are ideal candidates for computerized data acquisition and control. As the performance of microcomputers rapidly increases and cost continues to go down the temptation to automate the laboratory becomes great. To the novice computer user the choices of hardware and software are overwhelming and sadly most of the computer sales persons are not at all familiar with real-time applications. If you want to bill your patients you have hundreds of packaged systems to choose from; however, if you want to do real-time data acquisition the choices are very limited and confusing. The purpose of this chapter is to provide the novice computer user with the basics needed to set up a real-time data acquisition system with the common microcomputers. This chapter will cover the following issues necessary to establish a real time data acquisition and control system: Analysis of the research problem: Definition of the problem; Description of data and sampling requirements; Cost/benefit analysis. Choice of Microcomputer hardware and software: Choice of microprocessor and bus structure; Choice of operating system; Choice of layered software. Digital Data Acquisition: Parallel Data Transmission; Serial Data Transmission; Hardware and software available. Analog Data Acquisition: Description of amplitude and frequency characteristics of the input signals; Sampling theorem; Specification of the analog to digital converter; Hardware and software available; Interface to the microcomputer. Microcomputer Control: Analog output; Digital output; Closed-Loop Control. Microcomputer data acquisition and control in the 21st Century--What is in the future? High speed digital medical equipment networks; Medical decision making and artificial intelligence.
In 1984 the Western Consortium for the Health Professions, Inc., under contract to the United Nations Fund for Population Activities (UNFPA), began a project to assist Bangladesh's National Institute for Preventive and Social Medicine (NIPSOM) in establishing a microcomputing capability. The project's goal was to enable NIPSOM to become self-sufficient in the analysis by microcomputer of health, population, and family planning data; program evaluation; and policy activities. Lack of a local microcomputer infrastructure demanded that a local team of experts be developed to run the system described in a previous report. Five NIPSOM faculty members--three of whom had taken the workshop held when the system was first installed--were assigned to a computer committee, which was responsible for the computer's well-being. Six months after the microcomputer system was installed, a second 2-week workshop was given. The consortium's consultant facilitated the development of a basic microcomputer course, which was taught by four members of the computer committee to an additional eight NIPSOM faculty members. Emphasis was placed on developing local self-reliance and the need to overcome obstacles imposed by the lack of local hardware and software support systems. A strategy is proposed for the successful introduction of microcomputers in developing countries.
Writing courseware with the aid of an authoring system is a bold step that can bring together the health education content expert and the power of the microcomputer. The microcomputer can be programmed to present essential knowledge to students in a low pressure setting, specifically geared to their levels of comprehension and rates of progression. Microcomputer-based simulations and patient management problems seem suited to the task helping students develop adequate problem-solving skills in health education (Lewis, 1983; Peterson, 1984). Furthermore, many lecture hours can be replaced by an infinitely patient tutor with which students can interact at their convenience. Creating self-study materials delivered via microcomputer is also a step toward providing the most effective type of learning experiences for individual students. Despite the fact that putting authoring systems in the hands of well-informed content specialists may meet a number of pressing needs in health education, there is one drawback. Authoring systems have a built-in pedagogical structure that, to some extent, dictates the design of the lesson. However, spending time in the evaluation process prior to purchase will enable educators to identify a system that can be used to develop courseware that very closely matches the desires of the author. Integrating microcomputer courseware into health education courses is certainly an attractive solution to some of the educational problems faced in health education today. An authoring system can be used to develop courseware that can substituted for lectures on basic concepts. In addition, students will have more opportunities to develop the ability to apply, in problem-solving situations, the factual knowledge they are learning before they are responsible for making judgments in real-life situations. The time is ripe, then, for health educators to investigate how authoring systems can help them utilize the technology of the microcomputer to improve health education.
OBJECTIVE: The aim of this study was to evaluate the predictive value of bone mineral density and intracortical porosity measured by microcomputed tomography for the strength of cortical bone biopsies. DESIGN: Experimental study comparing the predictive value of bone mineral density and of intracortical porosity determined in vitro by microcomputed tomography for the mechanical properties of cortical bone cylinders. BACKGROUND: The assessment of cortical bone strength might be relevant for the prediction of fracture risk or the choice of suitable therapy strategies in orthopaedic surgery. The predictive value of cortical density for the mechanical properties is discussed controversially. The relevance of intracortical porosity measured by histomorphometry has been established, but the predictive value of porosity determined by microcomputed tomography remains to be explored. METHODS: Femoral cortical bone specimens from the mid diaphysis of 24 patients were harvested during total hip replacement procedure at the location, where a diaphyseal hole (diameter 4.5 mm) was drilled in order to reduce the intramedullary pressure. In vitro intracortical porosity and bone mineral density measurements by microcomputed tomography were compared with strength and elastic modulus assessed by a compression test transverse to the Haversian systems of the same specimens. RESULTS: Significant negative correlations were found between porosity measured by microcomputed tomography scans and yield stress, stiffness and elastic modulus (P<0.001), however, the positive correlations between bone mineral density and mechanical parameters were stronger (P<0.0001). The mechanical parameter best predicted by mineral density as well as by porosity was yield stress (r=0.72,P<0.0001;r=-0.64,P<0.001). CONCLUSIONS: Bone mineral density determined by microcomputed tomography imaging in vitro may be a potent method to predict mechanical properties of cortical bone non-destructively. The application in vivo remains to be explored.
This paper presents a snapshot view of the influence and direction of microcomputer technology for image analysis techniques in diagnostic pathology. Microcomputers have had considerable impact in bringing image analysis to wider application. Semi-automated tracing techniques are a simple means of providing objective data and assist in a wide range of diagnostic problems. From the common theme of reducing subjectivity in diagnostic assessment, an extensive body of research has accrued. Some studies have addressed the need for quality control for reliable, routine application. Video digitizer cards bring digital image analysis within the reach of laboratory budgets, providing powerful tools for investigation of a wide range of cellular and tissue features. The use of staining procedures compatible with quantitative evaluation has become equally important. As well as assisting scene segmentation, cytochemical and immunochemical staining techniques relate the data to biological processes. With the present state of the art, practical use of microcomputer based image analysis is impaired by limitations of information extraction and specimen throughput. Recent advances in colour video imaging provide an extra dimension in the analysis of multi-spectral stains. Improvements will also be felt with predictable increase in speed of microprocessors, and with single chip devices which deliver video rate processing. If the full potential of this hardware is realized, high-speed, routine analysis becomes feasible. In addition, a microcomputer imaging system can play host to companion functions, such as image archiving and transmission. With this outlook, the use of microcomputers for image analysis in diagnostic pathology is certain to increase.(ABSTRACT TRUNCATED AT 250 WORDS)
The picture naming articulation test, one of the most widely used speech assessment procedures, provides an excellent paradigm to study the potential of microcomputers with young, speech involved children. The stimulus-response format of the articulation test is structurally similar to assessment and management procedures crossing the spectrum of speech disorders. Findings from three studies comparing booklet-presented pictures to microcomputer-presented graphics indicate that microcomputers have certain control advantages in motivating children's repeated trials. However, spontaneous articulation testing by microcomputer may take more time than booklet testing if the graphics are less readily identifiable and due to associated novelty effects. Discussion of findings includes suggestions for enhancing the client-clinician-computer interface as this discipline experiences the entry of microcomputers into the speech-language clinic.
A microcomputer reconstruction technique has been developed in order to permit a larger exploitation of stereomicroscopy. The microcomputer facility consists of a digitizing tablet, a microcomputer, a graphics terminal, a graphics plotter and a printer. The technique has been applied to the study of HVEM stereopairs, performed by recording two images of the same area of a specimen (thick section of araldite-embedded leech ganglion neurons), tilted relative to the beam axis through an angle 0/20 degrees. Coordinates of N conjugate points of interest, expressed in a common reference system were obtained with the help of a digitizing tablet and the misorientation between the two images was determined by a method based on a least square technique. New projections of the object on different planes are provided by the microcomputer facility. Also the microcomputer method permits to obtain new stereopairs drawings, in various orientations and slices from a three-dimensional reconstruction of the object oriented in any direction in space. The method permits to obtain computed anaglyph drawings, printed here, which are stereoviews of the same object.
Thirty four Ontario Rehabilitation units were surveyed to determine how occupational therapists use microcomputers for patient treatment. Twelve rehabilitation units (35.3% of the sample) presently have microcomputers and 11 of these units have recently purchased the microcomputer for clinical use. Stroke, head injury and spinal cord injury patients were identified as the population that use the microcomputer. The APPLE 11 microcomputer was the most popular type chosen by rehabilitation units. Commercially available software programs are used for cognitive, perceptual, educational and recreational purposes. Satisfaction level with the quality of the software, however, was only 42.8%. Finally, it was noted that the speech therapist was the primary professional who liaised with the occupational therapist.
OBJECTIVE: To assist with educational planning we surveyed health sciences faculty members in 1989 to determine their use of microcomputers, desire for further instruction and perceptions on what microcomputer services should be provided for students. The 1989 results were compared with those of a similar survey performed in 1986. DESIGN: A self-completed, mailed questionnaire, with up to three reminders. SETTING: Faculty of Health Sciences, McMaster University, Hamilton, Ont. PARTICIPANTS: All full-time (FT) and part-time (PT) faculty members were sent the questionnaire; over 80% of the FT and 65% of the PT faculty members responded in 1986 and in 1989. RESULTS: The proportions of faculty members who used microcomputers increased significantly over the 3 years, from 71% to 87% among FT members (p = 2.2 x 10(-8)) and from 48% to 69% among PT members (p = 4.9 x 10(-8)). There were significant increases in the use of many of the applications, especially database and filing uses (from 10% to 41% among FT members [p less than 1 x 10(-9)] and from 6% to 34% among PT members [p less than 1 x 10(-9)]) and on-line access to bibliographic databases (from 7% to 37% among FT members [p less than 1 x 10(-9)] and from 3% to 18% among PT members [p less than 1 x 10(-9)]. These changes occurred mainly through individual initiative and voluntary continuing education. CONCLUSIONS: The extraordinary rate of adoption of microcomputers attests to their perceived usefulness. Curriculum planners need to consider how the success of microcomputer applications can be evaluated objectively and how successful applications can be integrated into educational programs.
The implementation and uses of a microcomputer in a 186-bed pediatric hospital are described. A Kaypro-10 portable microcomputer and an Epson Fx-80 printer were purchased in anticipation of increased workload generated by addition of beds to the hospital's neonatal intensive-care unit. Programs in C-BASIC language were developed for performing mathematical calculations, labeling of unit dose injections and oral liquids, and generating automatic-stop-order renewal notices. A master menu was designed to allow access to all programs. Work sheets to aid in the calculation of solution volumes required to deliver desired dosages of emergency drugs and for preparation of parenteral nutrient solutions are generated by the microcomputer, along with labels for these solutions. Other computer programs allow charging of floor stock items for i.v. admixtures, tracking of emergency-drug boxes, and generation of controlled-substances and anaphylaxis-dosing labels. A total of 510 hours was required to develop the microcomputer programs at a salary cost of $2600. Hospital pharmacies experiencing an expansion of patient services may be able to reduce the impact of the increased workload on manpower requirements by computerizing existing systems. Pharmacies with specialized needs can consider microcomputer implementation and inhouse software development as one alternative.
Regrettably, because the content and technology are evolving so rapidly the literature on the application of microcomputer technology to health and development is either out of date, or hard to find (e.g. unpublished reports from consultants working with development agencies or universities). The time needed to review and publish an article or a book dictates that by the time it is published, any statements about current hardware will be obsolete. For example, a recent volume by Ingle et al., quite sound from the theoretical and practical point of view is already out of date with respect to hardware details. For that reason no hardware suggestions are made in this article. On the other hand, detailed reports of experience with first-generation microcomputers are very useful to the individual planning a developing country application. From the literature and our own field experience with respect to microcomputer applications in health/population surveys in developing countries, the following are useful summary points for projects currently going into the field. Careful planning is absolutely necessary if microcomputer technology is to be applied successfully to field data collection problems. Search out organizations with similar experiences. Collaboration among staff at all levels is essential for a system to be installed and utilized effectively. The particular technology combination selected must be adapted to the field situation. Remember survey complexity and size. Training is essential, and should be on-the-job and oriented towards specific tasks. If time consuming and repetitive tasks are given over to the microcomputer the technology will be readily accepted and fully utilized. To the extent that a community of users can be formed, the entire adoption process will be stimulated and results improved. Most maintenance and some repairs should be carried out in the field by local project personnel. For most survey and data acquisition problems some custom programming will be needed; this requires a good working knowledge of a powerful programming language (although this is likely to change in the near future). For descriptive statistics and small data management problems off-the-shelf software is appropriate but can be expensive. Compare options. Standardization and compatibility must be considered in all applications. This is important!(ABSTRACT TRUNCATED AT 400 WORDS)
Principles in selecting a microcomputer system for use in a home health-care (HHC) service and potential applications for an HHC microcomputer system are described. To ensure that the quality of care provided to patients at home is comparable with that provided to inpatients, HHC services must be well organized, provide adequate channels of communication among staff members, and maintain complete and accurate records of the selection, training, therapy, evaluation, and follow-up of all home-therapy patients. A well-designed microcomputer system can increase the efficiency and accuracy with which those goals are met. Selection of a system should be based on the needs of a particular HHC service; factors that should be considered include whether the system will be compatible with other hospital computer systems and whether the majority of users will be able to operate the program easily. Potential applications for an HHC microcomputer system include printing labels for home-therapy products, calculating prices and providing billing data, maintaining prescription files, generating reports for drug-use review, and monitoring inventory levels. By employing an organized approach to the selection and implementation of a microcomputer system for a home health-care service, hospital pharmacists can make an important contribution to improving HHC service operations.