Computer assisted management of information in an intensive care unit

Summary In order to use the capability of computers for handling large amounts of information, we developed a program for the acquisition, handling, storage and retrieval of administrative and clinical information generated in the 20 bedded multidisciplinary critical care unit of a University Hospital. At an initial phase a personal computer (PC) was used to collect information from 4362 patients, that included registration data, coded admission problems, techniques and special treatments, and final diagnosis. This information combined with free text provided a discharge report. Complementary programs allowed calculation and storage of hemodynamic and gas exchange parameters. This experience led to a second phase in which a computer with microprocessor Intel 80386 at 25MHz, 8MB RAM, 310 MB hard, disk and a streamer for 150MB cartridge tape back up, using UNIX operating system, permitted multiple users working simultaneously through 1 central console and 7 ASCII terminals. Data input included demographic data, previous and admission problems in coded form, present history and physical examination in free text, list of present problems in coded form, comments on evolution, record of special techniques and treatments, laboratory data, treatment, final diagnosis and facility for using all the information to elaborate the final report. Side modules provide help for drugs dosing, protocols for specific conditions and clerical routines. The system is open for connection to other areas of the Hospital. Data from more than 2000 patients have been included so far. The program is used by medical, nursing and clerical staff with high degree of acceptance. All patients have their clinical information filed and 100% of the final reports are elaborated with the program.We conclude that a PC supported application is not adequate for implementing a historical database. On the contrary the integration of a relational database management system with a text editor in a more potent multiuser set up, provides a highly efficient tool to handle all the data generated during the patients' admission.     

Transient Data Stream Dissociation in Computerized Data Acquisition System Masquerading as a Sensing Abnormality

During testing of a CPI model 1715 ICD, an apparent sensing abnormality was noted following shock delivery for VF. Close inspection of the recording prior to the defib-rillation attempt revealed that the surface leads spontaneously lost 848 ms of data while the event marker was unaffected. Computer simulations revealed that an inadequate buffer size for the ampHfied (surface ECC) data was the likely source of data loss. It is important to recognize tbat a discordance between surface leads and event marker may represent an abnormality in tlie data acquisition system and simulate an ICD or lead malfunction.     

CT诊断原发性腹膜后肿瘤的初步探讨

目的探讨原发性腹膜后肿瘤CT诊断。方法本组经病理证实36例,CT平扫36例,增强32例。结果腹膜后左侧14例,右侧16例,双侧6例;脂肪肉瘤1l例,平滑肌肉瘤5例,神经母细胞瘤7例,畸胎瘤8例,淋巴管瘤5例。结论CT能对原发性腹膜后肿瘤定位、定性诊断提供可靠影像学依据,定位优于定性。     

Use of Computer Technology to Enhance Immigrant Families'' Adaptation

PURPOSE: To summarize how computer technology influenced immigrant families' adaptation to life in the United States. DESIGN: Critical ethnography. METHODS: Data were collected from 1998 to 2000 from 13 parents and 16 children from nine Taiwanese immigrant families using semi-structured interviews and a questionnaire. Narrative analysis was used with interview data. FINDINGS: Participants faced the demands of language proficiency, economic survival, loss of social networks, and social disconnection during resettlement. Computer technology provided participants with new occupational opportunities and strategies to overcome the barriers and stress created by resettlement. Internet and E-mail access greatly facilitated these participant families' adaptation. CONCLUSIONS: Study findings warrant further exploration to assess bow new computer technology promotes immigrant families' adaptation and alleviates stress associated with resettlement, including information about their health and health care.     

长骨骨化性纤维瘤的X线与CT诊断

目的：回顾分析长骨骨化性纤维瘤的X线与CT表现，探讨X线与CT诊断价值。方法：14例经手术病理证实的长骨骨化性纤维瘤，所有病例均行常规X线检查，其中6例同时采用常规CT平扫，层厚、层距5mm。结合文献，综合分析。结果：病变位于胫骨11例，股骨3例，起自骨干皮质12例．中心者2例。主要X线与CT表现为溶骨性骨质破坏．偏心膨胀性生长，粗细不均的骨性间隔，边缘增生硬化及骨化。根据其表现可分为囊状型8例、混合型4例和骨化型2例。结论：X线检查对长骨骨化性纤维瘤的诊断及鉴别诊断是有价值的。CT较X线平片能更好地显示病变结构及邻近软组织改变。结合CT检查，能提高诊断准确率。     

The use of personal digital assistants by nurse practitioner students and faculty

PURPOSE: To describe the prevalence and patterns of use of personal digital assistants (PDAs) by nurse practitioner (NP) students and faculty, examine relationships between patterns of use of PDAs and demographic characteristics of NP students and faculty, and describe patterns of use of PDAs that support evidence-based practice (clinical scholarship). DATA SOURCES: Responses to a 20-item questionnaire administered via electronic or postal mail from 227 NP students and faculty. CONCLUSIONS: A majority (67%) of the participants used PDAs. Use was higher among men (82%) than women (64%) (p < .05). On average, respondents who used a PDA (N = 153) had been using it just over a year (M = 13 months). Respondents reported using a PDA most days of the week (M = 5 days). The top three medical software programs identified by respondents as the most useful in clinical practice were ePocrates Rx (82%), Griffith's 5-Minute Clinical Consult (26%), and MedCalc (22%). Most participants (96%) related that PDA use supported clinical decision making. IMPLICATIONS FOR PRACTICE: Personal digital assistants may facilitate the application of evidence-based knowledge to practice. However, until there is evidence that PDA software is valid and reliable, clinicians should continue to use a multitude of references to assure the quality and safety of care provided.     

电子教学网页与邮件信息在临床护生带教中的应用

笔报道电子教学网页与邮件信息在临床护生带教中的应用，阐述做法；（1）建立科室护生带教小组；（2）应用网络运行技术建立数学环境；（3）开展护理教学查房，完善网络运行下信息化教学模式；（4）通过护生临床实习问卷调查结果与效果评价，在计算机电子网页临床护生带教的方法，手段，内容，质量与效果方面，认为信息化临床带教模式优于传统护生临床带教，有效提高了护生临床实习的内在质量。     

Feature rich,but user-friendly: Speech pathologists’ preferences for computer-based aphasia therapy

Purpose: High-intensity language therapy has been shown to provide greater outcomes for people with aphasia (PWA). Unfortunately, a number of issues including the ageing population and a lack of rurally-based clinicians prevent high-intensity interventions. Computer-based therapies are a potential solution to the issues of intensity and accessibility; however, this service delivery model is not commonly used. A possible reason behind the poor uptake is that current computer-based aphasia therapy (CBAT) programs may not meet the needs of speech-language pathologists (SLPs). This study investigated the preferences of SLPs with regard to the features desired in their ideal CBAT program.

Method: Phenomenological research methodology was used to explore the preferences of 10 SLPs. Data were analysed using qualitative thematic analysis.

Result: Desired features were grouped into five themes: therapy activities, stimuli, cues, access and progress data. A range of sub-themes were also identified.

Conclusion: The wide range of desirable features found in this study may reflect the extent to which current CBAT programs are considered to be useful, but perhaps do not meet the needs of users. The study’s findings provide useful information for future CBAT developers to create programs with high clinician usability.     

Subclinical cardiovascular disease and Systemic Sclerosis: A comparison between risk charts,quantification of coronary calcium and carotid ultrasonography

Background and objectives

Recently published population-based cohort studies have shown a high prevalence of cardiovascular disease in Systemic Sclerosis (SSc) patients. The aim of this study is to compare three different methods to measure cardiovascular risk in patients with scleroderma.