[Justification of regulations for the use of computers with LCD monitor during academic studies].

In the article there are reported the results of studies of the effect on the functional state of the body of schoolchildren curriculum with the use of personal computers with LCD monitors. The resistance to the development of visual and general fatigue in schoolchildren -users of personal computers with LCD monitors was found to be higher because they provide a more favorable environment for visual work in comparison with monitors based on cathode-ray tube. The use of LED lighting in classrooms contributes to the creation a more favorable light environment than in fluorescent lighting and reduces fatigable impact (both general and visual) of classes with the use of personal computers.

Clinical evaluation of the Jay Sensitivity Sensor Probe: a new microprocessor-controlled instrument to evaluate dentin hypersensitivity.

PURPOSE: To compare the Jay Sensitivity Sensor Probe (Jay Probe), a new microprocessor-based, pre-calibrated instrument, with well accepted methods used to evaluate sensitivity, i.e. tactile response to the Yeaple Probe, air blast (Schiff scale), and patient responses by Visual Analog Score (VAS). METHODS: Jay Probe assessments were accomplished using several approaches. With a cohort of 12 subjects, two clinical examiners compared the repeatability of the Jay and Yeaple Probes. A second evaluation of both probes was conducted during two independent parallel design clinical studies each enrolling 100 adults with dentin hypersensitivity (DH). In each study, subjects were evaluated for DH responses after twice daily oral hygiene with a negative control fluoride dentifrice or a positive control dentifrice formulated with ingredients proven to reduce sensitivity, i.e. potassium nitrate or 8.0% arginine with calcium carbonate. Tactile evaluations by the Jay and Yeaple Probes were conducted at baseline and recall visits over the 8-week duration of each study. Also evaluated at each visit were responses to air blast and to patient reported DH assessment by VAS. RESULTS: Low inter-examiner variability with no significant differences between replicate measurements (P > 0.05) was observed with the Jay Probe. Consistent with results from previous studies, subjects assigned dentifrices formulated with potassium nitrate or 8% arginine/calcium carbonate demonstrated improvements in Yeaple, air blast and VAS responses in comparison to those assigned the fluoride dentifrice (P < 0.05). Jay Probe responses correlated significantly with all other sensitivity measures (P < 0.05). Differences between these treatments were observed at all post-treatment evaluations using these methods.

Octopus Watch Fosters Family Resilience by Enhancing Occupational Engagement for Children with Spina Bifida and/or Hydrocephalus: Pilot Study.

BACKGROUND: Children with spina bifida and/or hydrocephalus (SB&/H) often experience difficulties with activities of daily living (ADLs) due to impaired executive functioning, increasing sedentary behaviours. The HeyJoy Octopus watch, a child-friendly icon-based smartwatch could be used as an enabler to promote purposeful ADLs (i.e., goal-orientated ADLs). OBJECTIVE: to investigate the effectiveness of the Octopus watch in promoting purposeful ADLs for children living with SB&/H (<8 years). METHODS: Mixed-methods engaging parents and children in four phases: (1) Administered demographic questionnaire, semi-structured interview, childhood executive functioning inventory (CHEXI) and the Canadian occupational performance measure (COPM); focus group one introducing the study, information pack using smartwatch and photovoice data collection methods. (2) Measured baseline movement for four days with smartwatch without using functions. (3) Measured activity for 16-days while using the smartwatch. (4) Re-administered assessments and conducted a second focus group based on photovoice narratives. RESULTS: movement data recorded for four participants, three of four showed mean activity increase (36%). N-of-1 analyses found one participant showed clear improvement (p = 0.021, r2 = 0.28). Mean inhibition decreased by 16.4%, and mean change in COPM performance and satisfaction scores were 2.1 and 2.4, respectively. The photovoice narrative focus group supports findings evidenced with improved daily routines. CONCLUSIONS: The Octopus watch is an innovative early intervention that can promote purposeful ADLs, fostering family resilience by enhancing occupational engagement. Further research is required.

Development and quality assurance of computer-based assessment batteries.

The purpose of this article is to outline critical elements in the development and quality assurance (QA) assessment of a computer-based assessment battery (CAB). The first section of the article provides an overview of the life cycle of a representative CAB, typical evolutionary stages, and many of the essential considerations for designing and developing a CAB. The second section of the article presents a model for conducting a quality assurance assessment of a CAB. A general narrative of several steps in the QA process is supported by a table of recommended QA assessment elements. Although this QA process model may not be definitive for all cases, it provides a general framework within which a systematic assessment of any CAB can be conducted.

e-Knee: the electronic knee prosthesis.

Tibiofemoral forces determine polyethylene wear and affect the longevity of total knee prostheses. Previously, investigators relied on theoretic data from mathematical models to predict mechanical forces in the knee. Predictions of tibiofemoral forces are highly variable because of the complex interplay of the muscles involved in activities. Ideally, knee forces should be directly measured. An electronic total knee prosthesis (e-Knee) was developed to directly measure tibiofemoral compressive and tensile forces in vivo. After 13 years of research and development, the e-Knee was implanted into a patient in 2004. Tibiofemoral force data were collected intraoperatively and throughout the postoperative period during activities of daily living and during exercise. Direct measurement of knee forces can lead to a better understanding of the stresses seen following total knee arthroplasty. Information generated by the e-Knee will aid in the improvement of implant design and patient care.

Electrical safety Q&A. A reference guide for the clinical engineer.

This guide, which ECRI developed to answer the electrical safety questions most frequently asked by member hospitals, features practical advice for addressing electrical safety concerns in the healthcare environment. Questions addressed include: STANDARDS AND APPROVALS: What electrical safety standards apply? How do NFPA 99 and IEC 60601-1 differ? What organizations approve medical devices? LEAKAGE CURRENT LIMITS AND TESTING: How are leakage current limits established? What limits apply to equipment used in the hospital? And how should the limits be applied in special cases, such as the use of PCs in the patient care area or equipment used in the clinical laboratory? ISOLATED POWER: What are its advantages and disadvantages, and is isolated power needed in the operating room? Other topics addressed include double insulation, ground-fault circuit interrupters (GFCIs), and requirements for medical devices used in the home. Supplementary articles discuss acceptable alternatives to UL listing, the use of Hospital Grade plugs, the limitations of leakage current testing of devices connected to isolated power systems, and the debate about whether to designate ORs as wet locations. Experienced clinical engineers should find this guide to be a handy reference, while those new to the field should find it to be a helpful educational resource.

Measurement of drug compliance by continuous electronic monitoring: a pilot study in elderly patients discharged from hospital.

OBJECTIVE: A pilot study to assess patient compliance with medication by using a new measurement technique, continuous electronic monitoring. DESIGN: Survey. Compliance monitors were provided to eligible patients at discharge from the hospital to measure drug intake behavior prospectively for a period of 3 weeks. SETTING: Ambulant patient care after discharge from a geriatric hospital, Krankenhaus Bethanien, which is affiliated with the University Clinic, Heidelberg. PATIENTS: A consecutive convenience sample of 18 independently living elderly patients (median age 76 years) completed the study. The patients were on maintenance therapy with cardiac glycosides and/or potassium-sparing diuretics prescribed to be taken once daily. INTERVENTION: The monitoring method provides information about patients' real timing of drug use by continuously recording date and time of openings and closings of the medication containers (monitors). In addition to a standard measure, the percentage of prescribed doses taken, information about regularity of drug use is obtained. RESULTS: Compliance, percentage of prescribed doses taken, was remarkably variable; it ranged from 24% to 100%, 95% CI: 62%-84%. Mean compliance declined from the first to the third week after discharge, 85% vs 69%, 95% CI: 74%-95% and 56%-81%, respectively (P < 0.05). Omissions of doses, the predominant pattern of non-compliance, were observed in 17 of 18 patients. Regularity of dose timing, as defined by the number of interdose intervals within 24 h +/- 15%, varied from 10% to 100%, 95% CI: 46%-76%. CONCLUSIONS: Continuous electronic monitoring revealed highly variable compliance in patients prescribed maintenance therapy. Even with a once-daily regimen, persistent and high compliance cannot be assumed. The monitoring technique may be of great value to research and, possibly, to practical therapeutic management.

Extended dynamic clamp: controlling up to four neurons using a single desktop computer and interface.

The dynamic clamp protocol allows an experimenter to simulate the presence of membrane conductances in, and synaptic connections between, biological neurons. Existing protocols and commercial ADC/DAC boards provide ready control in and between < or =2 neurons. Control at >2 sites is desirable when studying neural circuits with serial or ring connectivity. Here, we describe how to extend dynamic clamp control to four neurons and their associated synaptic interactions, using a single IBM-compatible PC, an ADC/DAC interface with two analog outputs, and an additional demultiplexing circuit. A specific C++ program, DYNCLAMP4, implements these procedures in a Windows environment, allowing one to change parameters while the dynamic clamp is running. Computational efficiency is increased by varying the duration of the input-output cycle. The program simulates < or =8 Hodgkin-Huxley-type conductances and < or =18 (chemical and/or electrical) synapses in < or =4 neurons and runs at a minimum update rate of 5 kHz on a 450 MHz CPU. (Increased speed is possible in a two-neuron version that does not need auxiliary circuitry). Using identified neurons of the crustacean stomatogastric ganglion, we illustrate on-line parameter modification and the construction of three-member synaptic rings.

Requiring students to have computers: questions for consideration.

For the past several years a dialogue has been taking place in the offices, lounges, and meeting rooms of medical schools about whether medical students should be required to bring or purchase computers when they enter school. Microcomputers offer educators a unique opportunity to provide students with access to computer-assisted instruction, asynchronous communication, and extensive knowledge bases. However, there is still no evidence attesting to the effectiveness of computers as teaching or learning tools in medical education. The author raises questions that schools need to consider before requiring students to own computers: What kind of computer best suits their needs? What might impede using computers to teach? And who is currently requiring computers? In addressing the last question, the author presents information about 15 North American schools that currently require their students to have computers, reporting each school's software and hardware requirements; how each expects students to use the computers; and who covers the cost of the computers (the students or the school). Finally, he argues that major institutional commitment is needed for computers to be successfully integrated into any medical school curriculum.

Managing information technology in academic medical centers: a "multicultural" experience.

Based on a session at the 1997 conference on Information Resources and Academic Medicine sponsored by the Association of American Medical Colleges, this article illustrates how the beliefs and concerns of academic medicine's diverse professional cultures affect the management of information technology. Two scenarios--one dealing with the standardization of desktop PCs, the other with publication of syllabi on an institutional intranet--form the basis of this exercise. Four prototypical members of a hypothetical medical center community--the chairman of surgery, a senior basic scientist, the chief information officer of an affiliated hospital, and the chief administrative officer--offer their perspectives on each scenario. Their statements illustrate many of the challenges of planning, deploying, and maintaining effective information technology in the "multicultural" environment of academic medical centers.

A comprehensive microcomputer network program for histopathology.

For a small hospital with a limited budget, a stand-alone histopathology microcomputer network may be more valuable to the pathologist than one running off the hospital's main computer. In return for sacrificing the limited benefit of screen reading of pathology reports in the wards, one receives the great advantage of more rapid retrieval of disease data. Commercial relational database programs for microcomputers can now achieve nearly all the power of a minicomputer program, with more versatility. Using an application developed on such software, we now have 30,000 pathology reports entered, from which we can retrieve a list of pathology numbers, with patients' names, age, sex, disease, and site, for any diagnosis in 3-5 seconds. The application includes full biopsy reports for doctors and wards, autopsy final diagnoses, computer-assisted Snomed coding, outside consultations, literature abstracts, daybook printing, workload statistics and billing codes and charges, and a cytology module has been added for another hospital. Moreover, the interested pathologist can easily make his own alterations to menus, entry screens, fields, and screen listing or printout formats.

Accuracy of drug infusion pumps under computer control.

Prototype systems implementing algorithms for automated drug infusions are typically constructed by coupling a microcomputer to a drug infusion pump through a serial communications interface. Infusion rates demanded of the infusion pump in many computed-controlled drug delivery applications are made to change at intervals much shorter than those encountered under routine clinical use. Because the ability of infusion pumps to maintain accurate flow rates during high frequency rate changes has not been documented, the purpose of this study was to validate the volumetric accuracy of three commercially available infusion pumps operating in a demanding computer-controlled application. In independent 2-h evaluations, the infusion rate demanded of each pump changed as often as every 5, 10, or 15 s using an algorithm for computer-controlled pharmacokinetic model-driven intravenous infusion. Accuracy of the infusion devices was determined gravimetrically. At all measurement times, each of the infusion pumps was accurate to within approximately +/- 5% of the expected volumetric output under each of the infusion rate intervals tested. Flow rate accuracy of +/- 5% is equal to the nominal expected accuracy of these infusion pumps in conventional clinical use.

A practical approach to soft-copy display consistency for PC-based review workstations.

The use of non-permanent, digital image display, i.e. soft-copy display, is increasing within hospitals due to the growth in the use of digital modalities and picture archiving and communication systems (PACS). Non-dedicated image review using standard PCs is being employed as a cost-effective method of image access. These workstations do not have specialized display systems and are likely to suffer from inconsistent image presentation. The Digital Imaging and Communications in Medicine (DICOM) Working Group 11 has developed a display function standard (part 14) to standardize the display of grey scale images. Although this standard is starting to be adopted by manufacturers of proprietary reporting systems it is not easily applied to the existing number of non-dedicated, PC-based review systems. The aim of this work was to investigate whether display consistency could be achieved simply and reproducibly on these systems, outside of the DICOM standard: part 14, by adjusting monitor brightness and contrast settings and using the Society of Motion Picture and Television Engineers (SMPTE) digital test pattern. The study showed that by adjusting the brightness and contrast settings alone it was possible to approximate the display characteristic curves to the grey scale standard display function (GSDF) defined in the DICOM standard: part 14, but only at unacceptably low luminances. Intradisplay and interdisplay consistency could be achieved using a simple monitor set-up procedure and the SMPTE test pattern.

The FPbase microcomputer system for managing community health screening and intervention data bases.

Health promotion and intervention projects at State and community levels need computerized data bases to assist in making policy decisions and in operating the projects. Computer data base systems are used in entering, storing, retrieving, and analyzing information about health project activities and their participants in a timely and cost-effective manner. Computer support is essential for such labor-intensive tasks as post-screening followup of participants, identifying subpopulations, and evaluating recruitment efforts and behavior change programs. The Pawtucket Heart Health Program developed a microcomputer software package, FPbase, for community health project data base management. FPbase is described and is available for use by other organizations. FPbase incorporates formative and process interactive data base activities and is suitable for use in operating intervention and screening programs at State and local levels. The system accommodates management of data for social marketing, evaluation, followup, and promotional activities.

Reliability and concurrent validity of the Metrecom for length measurements on inanimate objects.

BACKGROUND AND PURPOSE: The purpose of this study was to test the reliability and concurrent validity of length measurements (distance between two points) produced by a computer-interfaced, three-dimensional digitizer called the Metrecom. METHODS: A total of 344 points were marked on the surfaces of five different inanimate objects and were digitized in pairs with the Metrecom. On the first three objects, each of two testers digitized each point twice for each of two testing modes (Line Length and 3-D Digitizer); on the last two objects, only one mode (3-D Digitizer) was used. Intraclass correlation coefficients and Pearson Product-Moment Correlation Coefficients were used to assess reliability and concurrent validity, respectively. RESULTS: All of the correlation coefficients were > or = .99. In further analysis of the results, a repeated-measures, one-way analysis of variance (used with reliability data) and repeated-measures t tests (used with validity data) were used to test for differences between repeated measures. After adjustment of the alpha level for the total number of comparisons, two of the t tests for validity comparisons were significant. CONCLUSION AND DISCUSSION: The results indicate that the Metrecom provides reliable length measurements (distance between two points) on inanimate objects and that two different test modes produce consistent measurements. Further study of the validity and reliability of length measurements obtained with the Metrecom on humans under applied conditions is needed before the results of this study can be generalized to applied settings.

Quality control in the pulmonary function laboratory.

The addition of computers to pulmonary function laboratories has reduced quality-control problems. After standards for a test have been selected, the computer can enforce adherence to them. The computer can be programmed to perform periodic calibration checks and other self-diagnostic procedures to ensure that instrumentation and human errors have not gone undetected. The computer can be used to verify that reference values are within acceptable limits and that results for a particular patient are at least internally consistent. The computer greatly reduces the number of measurements and calculations that must be done by hand and therefore improves laboratory efficiency and reduces the probability of human error. Quality-control samples can be processed more frequently with the use of a computer because this task consumes less time than when done by laboratory personnel. Some disadvantages of quality control that have appeared since the introduction of the computer are the potential for undetected failure of computer hardware and software, a risk that has increased with the increase in software complexity, and the potential for the loss of large amounts of information because of its being stored on a single digital medium. To effect quality control in the pulmonary function laboratory one should (1) ensure that procedures and software conform to standards, (2) follow routine calibration-check procedures, (3) check test results for internal consistency and for consistency with other test results, (4) conduct periodic testing of a quality-control subject or reference sample, (5) continually evaluate software performance, (6) carefully evaluate changes in instrumentation and software, and (7) maintain duplicate copies of data on different types of mass storage media.

New technology in natural family planning.

In recent years, several new devices have been developed to help women achieve or avoid pregnancy. These devices include computerized basal body temperature thermometers, electronic fertility monitors, and chemical and hormonal ovulation detection kits. This article describes these new fertility devices and discusses their effectiveness and impact on helping women understand and control their fertility.

Microcomputer-based monitoring of cardiovascular functions in simulated microgravity.

A microcomputer-based system for non-invasive monitoring of cardiovascular system in simulated microgravity is described. The system evaluates automatically, accurately and interactively heart beat intervals, beat-to-beat non-invasive finger arterial blood pressure (systolic, diastolic, mean and pulse pressure) using a Finapres device and beat-to-beat changes of thoracic blood volume using impedance changes. In addition, beat-to-beat evaluation of cardiac mechanical function including left ventricular ejection time, diastolic time, systolic time intervals, left ventricular ejection fraction estimate and several other contractility parameters, left ventricular volume, stroke volume and cardiac output estimates are performed with high degree of automaticity.

IS & C system and file protection mechanism.

This paper reports a new extension of IS & C (Image Save And Carry) project. Because IS & C is an off-line system and requires full compatibility so as to enable medical data interchange with ease among hospitals and clinics, specifications that are indispensable for compatibility have been standardized by the IS & C committee. The IS & C system is supposed to be used in medicine, so the file protection mechanism for the security of the recorded files has been also developed. The characteristics of IS & C volume and file structure and the second national project being carried out in National Cancer Center Hospital are briefly explained as well.