Effects of physical and cognitive training on gait speed and cognition in older adults: A randomized controlled trial.

Gait speed is a measure of health and functioning. Physical and cognitive determinants of gait are amenable to interventions, but best practices remain unclear. We investigated the effects of a 12-month physical and cognitive training (PTCT) on gait speed, dual-task cost in gait speed, and executive functions (EFs) compared with physical training (PT) (ISRCTN52388040). Community-dwelling older adults, who did not meet physical activity recommendations, were recruited (n = 314). PT included supervised walking/balance (once weekly) and resistance/balance training (once weekly), home exercises (2-3 times weekly), and moderate aerobic activity 150 min/week in bouts of >10 min. PTCT included the PT and computer training (CT) on EFs 15-20 min, 3-4 times weekly. The primary outcome was gait speed. Secondary outcomes were 6-min walking distance, dual-task cost in gait speed, and EF (Stroop and Trail Making B-A). The trial was completed by 93% of the participants (age 74.5 [SD3.8] years; 60% women). Mean adherence to supervised sessions was 59%-72% in PT and 62%-77% in PTCT. Home exercises and CT were performed on average 1.9 times/week. Weekly minutes spent in aerobic activities were 188 (median 169) in PT and 207 (median 180) in PTCT. No significant interactions were observed for gait speed (PTCT-PT, 0.02; 95%CI -0.03, 0.08), walking distance (-3.8; -16.9, 9.3) or dual-task cost (-0.22; -1.74, 1.30). Stroop improvement was greater after PTCT than PT (-6.9; -13.0, -0.8). Complementing physical training with EFs training is not essential for promotion of gait speed. For EF's, complementing physical training with targeted cognitive training provides additional benefit.

Computerized training improves verbal working memory in patients with myalgic encephalomyelitis/chronic fatigue syndrome: A pilot study.

OBJECTIVE: Patients with myalgic encephalomyelitis/chronic fatigue syndrome experience cognitive difficulties. The aim of this study was to evaluate the effect of computerized training on working memory in this syndrome. DESIGN: Non-randomized (quasi-experimental) study with no-treatment control group and non-equivalent dependent variable design in a myalgic encephalomyelitis/chronic fatigue syndrome-cohort. SUBJECTS: Patients with myalgic encephalomyelitis/chronic fatigue syndrome who participated in a 6-month outpatient rehabilitation programme were included in the study. Eleven patients who showed signs of working memory deficit were recruited for additional memory training and 12 patients with no working memory deficit served as controls. METHODS: Cognitive training with computerized working memory tasks of increasing difficulty was performed 30-45 min/day, 5 days/week over a 5-week period. Short-term and working memory tests (Digit Span - forward, backward, total) were used as primary outcome measures. Nine of the 11 patients were able to complete the training. RESULTS: Cognitive training increased working memory (p = 0.003) and general attention (p = 0.004) to the mean level. Short-term memory was also improved, but the difference was not statistically significant (p = 0.052) vs prior training. The control group did not show any significant improvement in primary outcome measures. CONCLUSION: Cognitive training may be a new treatment for patients with myalgic encephalomyelitis/chronic fatigue syndrome.

Information technology in ENT: are we ready to be 'Connected For Health'?

The NHS Connecting for Health agency continues to implement the national programme for information technology within the National Health Service (NHS). In preparation, NHS employees are being encouraged to develop their information technology skills via the European computer driving licence training course. A postal survey of British Association of Otorhinolaryngologists members was undertaken to evaluate their levels of information technology training, competency and knowledge. Three hundred and thirty-six surgeons responded. Most respondents had received no formal information technology training. Only 3.9 per cent had taken the European computer driving licence course. Most surgeons felt comfortable using word processing and presentation software but were less comfortable with other applications. Junior surgeons were more confident in all areas of information technology application than senior surgeons. Seventy-two per cent of surgeons wanted more information technology training. Most felt that such training should be routine at undergraduate and postgraduate level. With the national programme committed to improving information technology infrastructure within the NHS, more formal training should be provided to ensure a basic standard of information technology competency amongst ENT surgeons.

Instructional set and internet use by low-income adults.

This research examined the effects of instructional set on Internet use by low-income adults during a 16-month longitudinal study. Participants (n = 117) received instructions that focused on either the Internet's communication tools or its information tools. Internet use was continuously and automatically recorded. Survey measures of computer and Internet experiences, affect and attitudes were obtained to examine their mediational role in the relationship between instructional set and Internet use. Results indicated that instructions focused on the Internet's information tools led to greater Internet use than instructions focused on its communication tools or only basic instructions about how to use the Internet. Implications for reducing the digital divide are discussed.

A survey of the information management and technology training needs of doctors in an acute NHS trust in the United Kingdom.

BACKGROUND: Doctors need information skills to deliver health care in the 21st century. There is concern that those who trained before the 'information age' will be inadequately equipped for their work. OBJECTIVES: To assess doctors' use of computers for clinical tasks, and their knowledge and skills in health information management and technology. DESIGN: Questionnaire survey. SETTING: An acute NHS trust in the UK. PARTICIPANTS: 96 (83%) of all doctors in the trust responded. MAIN OUTCOME MEASURES: Proportion of respondents reporting the following: use of computer-based systems for clinical tasks, knowledge in eight health informatics topics, skills in using specific hardware and software applications. Also comparison of reported skills between senior and junior staff; proportion of doctors identifying specific training needs. RESULTS: All but one (1%) of the responding doctors used a computer regularly. Over three quarters of respondents reported they were semi-skilled or fully skilled in basic office applications, though the juniors scored significantly more highly than the seniors for some applications. However, 44% of doctors reported no skills in database software, identifying this as a training need. Around half of the doctors were unaware of health informatics topics, including electronic patient records, the Caldicott report and data protection law. In each case the senior doctors were significantly more aware than the juniors of the topic in question. CONCLUSION: Both junior and senior doctors have basic computer literacy, but nearly half of this population identify the use of database software as a training need. In addition, there are several health informatics topics of which a large proportion of doctors, particularly the juniors, have little knowledge, but which have not been identified as training needs. Some recommendations are made for provision of in-house health informatics education for doctors.

Overcoming the barriers to using information systems.

AIM: To identify any barriers to the use of information technology by community nurses, such as poor access, insufficient time and a lack of appropriate skills. METHODS: Literature review and questionnaire. RESULTS: The study showed that a large majority of community nurses had access to IT. However, sharing facilities and varying clinical systems meant that, with the exception of e-mail, they made infrequent use of the applications provided. CONCLUSION: Despite some access difficulties, community nurses have a positive attitude to IT and would like to receive more training.

The Internet: an underutilized tool in patient education.

Internet technology is helping to reshape patient education. An illustration of this is provided by data from a two-stage pilot study involving 100 senior citizens who received instruction on how to conduct health information searches on the Internet. The goals were to enable the seniors to assume an active role in their health care and to share their information with family and friends. In a Train-the-Trainer approach, 20 trainers received instruction on searching for health information on the Internet, and subsequently trained 100 senior citizen trainees. The study was conducted from October 1997 to June 1998. The average age of the senior trainees was 69. Most had a college education. The study results reveal a positive impact of the training on senior trainee confidence in using the computer and the Internet, conducting health information searches online, and sharing health care information with their physicians, families, and friends. Some gender and educational differences were noted. In a 90-day posttraining follow-up, 66% of the trainees continued to use the Internet, with 47% of them using it to search for health information. Two thirds of those who searched for health information on the Internet talked about it with their physicians, with more than half reporting they were more satisfied with their treatment as a result of their searches and subsequent discussion with their physicians. These findings are relevant to patient education in the nursing curricula of nursing students and nurse practitioners. Some suggestions are given to improve the effectiveness of the training program.

Who's wired and who's not: children's access to and use of computer technology.

As computer technology becomes increasingly prevalent throughout society, concerns have been raised about an emerging "digital divide" between those children who are benefitting and those who are being left behind. This article presents results from new analyses of national survey data describing children's differential access to computers in school and at home, and the varying conditions that affect how children experience computers. For example, responses from a nationwide survey of teachers suggest that, as of 1998, more than 75% of students had access to computers at school. In fact, those teaching lower-income students reported weekly use of computers more often than those teaching higher-income students. But the nature of children's experiences using computers in school varied greatly by subject and teacher objectives, and the data suggest that lower-income students use computers more often for repetitive practice, whereas higher-income students use computers more often for more sophisticated, intellectually complex applications. Differences between low-income and high-income children's access to home computers were far less subtle. Survey data indicate that only about 22% of children in families with annual incomes of less than $20,000 had access to a home computer, compared to 91% of those in families with annual incomes of more than $75,000. And among children with access, those in low-income families were reported to use the computer less than those in high-income families, perhaps because most low-income families with computers lacked a connection to the Internet. The two most predictive factors of children's use of home computers were the child's age and the computer's capabilities. The author concludes that home access to computers will be a continued area of inequality in American society, and that schools must play a critical role in ensuring equal opportunity for less-advantaged children to access the benefits of the more intellectually powerful uses of computer technology.

A survey of the computer literacy of undergraduate dental students at a University Dental School in Ireland during the academic year 1997-98.

As dental practice management becomes more computer-based, the efficient functioning of the dentist will become dependent on adequate computer literacy. A survey has been carried out into the computer literacy of a cohort of 140 undergraduate dental students at a University Dental School in Ireland (years 1-5), in the academic year 1997-98. Aspects investigated by anonymous questionnaire were: (1) keyboard skills; (2) computer skills; (3) access to computer facilities; (4) software competencies and (5) use of medical library computer facilities. The students are relatively unfamiliar with basic computer hardware and software: 51.1% considered their expertise with computers as "poor"; 34.3% had taken a formal typewriting or computer keyboarding course; 7.9% had taken a formal computer course at university level and 67.2% were without access to computer facilities at their term-time residences. A majority of students had never used either word-processing, spreadsheet, or graphics programs. Programs relating to "informatics" were more popular, such as literature searching, accessing the Internet and the use of e-mail which represent the major use of the computers in the medical library. The lack of experience with computers may be addressed by including suitable computing courses at the secondary level (age 13-18 years) and/or tertiary level (FE/HE) education programmes. Such training may promote greater use of generic softwares, particularly in the library, with a more electronic-based approach to data handling.

A survey of the IT skills and attitudes of final year dental students at Bristol University in 1996 and 1997.

Surveys of final year dental students were conducted in 1996 and 1997 to see if there were any detectable differences in students' perception of their own information technology IT skills and attitudes towards information technology following the opening of a dedicated computer-assisted-learning (CAL) room. An increase was seen in students' confidence levels, with fewer assessing themselves as IT "beginners" (1996 = 36%; 1997 = 14%), and more assessing themselves as competent in some basic skills (52%; 41%). Although more students were found to be using basic computer facilities (word processing, email, the World Wide Web), there was little difference in attitudes towards these packages between the 2 years. There was a significant increase in the number of students agreeing or strongly agreeing with the statement "the use of IT had added value to this course for me" (1996 = 39%; 1997 = 67%). The main obstacle which was identified by students as a barrier to using IT was the lack of adequate training. Over half the students in both years felt that insufficient training had been provided to enable them to cope with the course without difficulty.

[A hygienic assessment of the work of students on Macintosh computers]. / Gigienicheskaia otsenka raboty uchashchikhsia na komp'iuterakh "Makintosh".

Various kinds of works of 6-11th-form schoolchildren on Macintosh computers were physiologically and hygienically assessed at the lesson of information science and computer engineering (ISCE), as well as typing. The fatigue of a visual analyzer was due to the time of looking through the data available on the display; the adverse changes of the higher nervous activity depends on the complexity of educational materials and the intensity of work on a computer. Three-hour studies in ISCE should be excluded from the time able of lessons as they do not meet hygienic requirements.

Multimedia and children in Turkey.

Multimedia will be regarded as essential tools for children to create their new world. The effects of television on young children's life have been well studied. Television differs, however, from other media, including the movies, in its pervasive impact on children. Children spend more time watching television than any other activity except sleeping. Overall 31% of children spent at least 4 hours a day watching television during weekday and 71.7% during weekend in Turkey. Television's influence on children is a function of the length of time they spend watching and the cumulative effect of what they see. Television may be a cause as well as a solution for many serious childhood problems. Excessive viewing of television has also been linked to aggressive behavior, violence, childhood obesity. On the other hand, television may act as a socializing agent and as a learning tool if the recommendations of American Academy of Pediatrics is learned by pediatricians, parents and broadcasters. The use of home personal computers in urban residence increased from 3.2% in 1993 to 6.5% by January 1998 in Turkey. Around 20% of computer households reported owing a modem. Internet has been using only for 5 years in Turkey. Nearly 40% of computer households also used CD-ROM equipment. The percentage of schools that have a computer laboratory is only 2.64%. On the other hand, multimedia allows students to move away from a uniform education for everyone to assert individual identity, liberalize education and management. It seems likely that, within the next few years, most of the countries with substantial internet infrastructure will use the internet as the major medium for disseminating information, including information on children. To prepare students for such a world demands that educational systems make the best possible use of all knowledge and technologies currently available.

User support for a library-managed online database search service: the BMA Library free MEDLINE service.

This paper discusses user support in the context of a library-managed online database search service. Experience is drawn from the British Medical Association (BMA) Library's Free MEDLINE Service. More than 9,600 BMA members, who are largely unfamiliar with computer communications and database searching, have registered as users of the service. User support has played a significant role in the development of the service and has comprised four main aspects: an information pack, a help desk, online help, and MEDLINE courses. The paper includes an analysis of help desk usage statistics collected from January 1996 through June 1996, and highlights other relevant research. Plans for further service enhancements and their implications in terms of future user support are discussed.

First-year family medicine residents' use of computers: knowledge, skills and attitudes.

OBJECTIVE: To identify the computer knowledge, skills and attitudes of first-year family medicine residents. DESIGN: Cross-sectional survey of family medicine residents during the academic year 1993-94; sampling began in July 1993 and ended in October 1993. SETTING: Canada. PARTICIPANTS: All 727 first-year family medicine residents, of whom 433 (60%) responded. OUTCOME MEASURES: Previous computer experience or training, current use, barriers to use, and comfort with and attitudes regarding computers. RESULTS: There was no difference in age or sex between the respondents and all first-year family medicine residents in Canada. French-speaking respondents from Quebec were underrepresented (p < 0.001). Only 56 respondents (13%) felt extremely or very comfortable with computer use. The most commonly cited barriers to obtaining computer training were lack of time (243 respondents [56%]) and the high cost of computers (214 [49%]) but not lack of interest (69 [16%]). Most residents wanted more computer training (367 [85%]) and felt that computer training should be a mandatory component of family medicine training programs (308 [71%]). CONCLUSIONS: Computer knowledge and skills and comfort with computer use appear low among first-year family medicine residents in Canada, and barriers to acquisition of computer knowledge are impressive. Computer training should become an integral part of family medicine training in Canada, and user-friendly applicable computer systems are needed.

Incorporating computer-based learning in a medical school environment.

A systematic multifaceted approach is effective in integrating computer-based learning in a medical school environment. The need to educate medical students in computer use, the growing economic constraints facing many medical schools, and the permeation of computer technology in the medical profession encourage collaboration across academic disciplines and services to meet well identified instructional needs through computer-based learning.

The Southeast Florida AIDS Information Network: a community outreach, specialized information system.

In the years ahead, end-user instruction will expand from the current models of curriculum- and institution-based programs for teaching MEDLINE to include outreach programs to unaffiliated users for teaching specialized database searching. The Southeast Florida AIDS Information Network (SEFAIN), a community-based information system targeting health care providers in a tri-county area, is an example of this new model. The components of SEFAIN and the results of the outreach and educational programs are presented. The advantages of these programs to both providers and librarians are highlighted. Comparisons are drawn between end users who take specialized information courses and those who take MEDLINE courses or no courses. These data will assist librarians in the justification and development of specialized information systems.

An analysis of transaction logs to evaluate the educational needs of end users.

End users at the University of Southern California (USC) have free access to the last ten years of MEDLINE through a local online system known as USCInfo. Librarians at USC Norris Medical Library provide documentation and offer formal and informal training on the use of the system to search MEDLINE. To assess the educational needs of the end users, 643 searches were analyzed. Although a high proportion (84%) of the searches were judged to be successful, the use of medical subject headings (MeSH) to obtain optimal results was low; only 20% of all successful subject searches employed MeSH. Also, the advanced features of the system were underutilized. While it is promising to learn that many end users are obtaining positive results, methods which will encourage end users improve their retrievals need to be developed.