Predicting the learning and consultation time in a computerized primary healthcare clinic.

Managers would like to know how long it takes healthcare service providers to achieve the same throughput of patients per day that they were used to with a pen-and-paper system. This study has been undertaken to derive a model for predicting the time it takes a service provider from a previously disadvantaged community to enter a patient's record in terms of his or her experience and the number of data units that have to be captured. A model was also derived to predict the average consultation time in terms of the number of data units that are captured by an experienced service provider. It can be inferred that healthcare service providers should be allowed at least 6 months of computerized system experience before any decisions about the success of the technology introduction can be made.

System requirements for a computerised patient record information system at a busy primary health care clinic.

A prototyping approach was used to determine the essential system requirements of a computerised patient record information system for a typical township primary health care clinic. A pilot clinic was identified and the existing manual system and business processes in this clinic was studied intensively before the first prototype was implemented. Interviews with users, incidental observations and analysis of actual data entered were used as primary techniques to refine the prototype system iteratively until a system with an acceptable data set and adequate functionalities were in place. Several non-functional and user-related requirements were also discovered during the prototyping period.

Software for primary healthcare in a developing country. Background and problem statement.

Nurses in primary healthcare (PHC) clinics carry a heavy administrative burden, much of which can be computerized. Advantages and disadvantages of computerization and issues related to patient records and other requirements of computerized systems are well documented. However, not much attention has been given to users' needs in PHC environments in developing countries. Users in township areas have very specific needs because of a lack of previous exposure to computers and a reluctance to change working habits. Some general software requirements that system developers should consider are discussed.

A comparison of a manual and a computer system in a primary health care clinic.

Previous research has shown that nurses providing primary health care in local clinics are burdened with extensive administrative duties. These administrative tasks are so time consuming that less time can be devoted to direct patient care, their primary function. Certain assertions have been made with regard to computerising the total environment of patient records, capturing statistical indicators, stock control, etc. It is said that computerising the clinic at the point of service will naturally lead to less time devoted to administrative tasks, thus increasing the time available for direct patient care. This study was done to determine whether this assertion is true. It was conducted by means of a combined quantitative and qualitative research design. The manual system and a computer system were quantitatively compared by means of various time measurements. The perceptions of patients and staff regarding computers were explored qualitatively by means of questionnaires. It was found that computerising the nurse's consulting room does not enhance the ratio between the time devoted to administrative tasks and the time devoted to patient care. In fact, the consultation time was longer with the computerised system than with the manual system. Some limiting factors in the computerisation process were discovered, the most important of which were the lack of computer literacy and typing skills of the nursing staff.

A computerised implementation of a minimum set of health indicators.

Three alternative approaches to computerise primary health care services as provided in clinics in South Africa are compared. The first approach implements a system based on a head-count approach using a minimum set of indicators. This system resembles the current manual system of tally sheets. The second and third approaches implement computer systems based on patient records. The second approach is based on a very limited data set, and the third utilizes a comprehensive demographic and clinical data set. The three alternatives are compared with regard to practicality, flexibility, ease of use, accuracy and completeness of statistical reports, and time utilisation. It is concluded that the flexibility of a patient-record approach, although more time consuming, is preferred. The second alternative is more feasible in a developing country with mostly computer-illiterate nurses. Ways in which such a system can be implemented in an environment with limited hardware resources are also proposed.

Child sexual abuse and gonococcal conjunctivitis. A case report.

An unusual presentation of child sexual abuse is reported. A 6-year-old girl developed a unilateral purulent conjunctival discharge. Neisseria gonorrhoeae was isolated from conjunctival and genital swabs. Genital examination and further enquiries by social workers confirmed a diagnosis of sexual abuse.

Ocular cysticercosis. A report of 13 cases.

Ocular cysticercosis does not usually present with signs of systemic involvement. Stool examination and eosinophil count are invariably negative, but computed tomography and agglutination tests are more commonly positive. This condition is more common in the vitreous cavity where it may cause diagnostic problems. Removal of the cyst is a standardised procedure, but the prognosis is poor because of severe ocular reaction to the cysts. Prevention of cysticercus infection is very important.

Effects of atracurium on intraocular pressure.

The effects of atracurium on intraocular pressure (IOP) were compared with those of pancuronium in 20 patients less than 45 years-of-age requiring surgery for trauma of one eye. After a standard premedication and the application of topical analgesia to the upper airway, anaesthesia was induced with thiopentone i.v. and the trachea was intubated without the use of neuromuscular blockade. Following 20 min of steady state anaesthesia during which measurements of IOP, arterial pressure, heart rate, FIO2, FE'CO2 and CVP were recorded, one group of patients received atracurium 0.45 mg kg-1 and the other pancuronium 0.1 mg kg-1. The observations were repeated for a further 15 min before surgery commenced. Neither atracurium nor pancuronium produced any change in IOP. Atracurium was associated with greater cardiovascular stability than pancuronium.