The feasibility of remote-controlled assistance as a search tool for patient education.

Patients often desire more information about their conditions than they receive during a physician office visit. To address the patient's information needs, a touchscreen information kiosk was implemented. Results from the first prototype identified interface, security, and technical issues. Misspelling of search terms was identified as the most observable cause of search failure. An experimental remote control assistance feature was added in the second prototype. The feature allowed a medical librarian to provide real-time remote help during searches by taking control of the patient's computer. Remote assistance improved patient satisfaction, increased ease of use, and raised document retrieval rate (86.7% vs. 56.7%). Both patients and librarians found the application useful. Reasons included its convenience and flexibility, opportunity for direct patient contact, ability to teach through direct demonstration, and complementing the librarian's role as an information gateway. The project demonstrated the feasibility of applying remote control technology to patient education.

[Detection of hyperketonemia with the aid of monitoring milk production and two milk tests]. / Detectie van hyperketonemie met behulp van beoordeling van de melkproductie en twee melktesten.

In addition, it is relevant to know to what extent milk production data can provide information about hyperketonaemia. In 12 selected herds, milk samples were collected from 114 cows that had been lactating for maximally 70 days. During regular milk testing, two additional milk samples were taken to assess the 'Nitroprusside test' and the 'Ketolac BHB' test. After collection of milk samples, blood samples were taken to measure serum beta-hydroxybutyric acid. The prevalence of hyperketonaemia appeared to vary between herds from 1 to 9 per 10 lactating cows. The sensitivity of the Nitroprusside test was higher than the sensitivity of the Ketolac BHB test at threshold values of beta-HBA > 1.5 mmol/l. The Ketolac BHB test in comparison to the Nitroprusside test appeared to provide a smaller chance of false-positive test results at a given level of sensitivity. The serum beta-hydroxybutyric acid concentration was correlated with milk yield/day and the milk fat concentration of an individual cow.

Informatics nurse specialist: roles in health care organizations.

The cost of managing and processing health care information is a significant component of hospital operating budgets, yet health care lags far behind other industries in the effective use of information technology. As nurses are the largest group of users of health care information, improving nurses' information management capability could have a significant impact. Informatics nurse specialists understand the concepts and technology of nursing information management and can provide operational and strategic benefits to nursing organizations. In this article, educational preparation, certification, and roles of informatics nurse specialists are discussed along with functions of health care information technology and nursing informatics.

Use of Iliad to improve diagnostic performance of nurse practitioner students.

Nurse practitioners (NPs) have dual goals as primary care providers, combining the traditional goals of nursing with extended goals as diagnosticians. Diagnostic reasoning, therefore, is a critical component of NP education. Iliad, a computerized diagnostic reasoning expert system, has been used effectively to teach diagnostic skills to medical students. A pilot study was undertaken to determine the effects of Iliad training on NP students' diagnostic skill performance and to identify technical and instructional issues of implementation. The study found that the use of Iliad improved NP students' diagnostic reasoning, and that the training effects were modified by prior nursing experience. Successful use of Iliad required planning, faculty commitment, and technical support.

Using computerized clinical nursing data bases for nursing research.

Computerized clinical nursing data bases (CCNDBs) have significant potential as sources of data for research on the processes and outcomes of nursing care. The emergence of nurse-managed practice sites, in which patient care is driven predominantly by nurses' decisions, has prompted renewed interest in using data from these practices to answer questions that are important to nurses. The purpose of this article is to articulate strategies for using CCNDBs for nursing research. Recognition of the differences between clinical and research data bases is essential. The steps involved in obtaining and using computerized clinical data can be grouped into three phases: (1) locating and accessing CCNDBs, (2) assessing the content and quality of the data, and (3) extracting and analyzing the data. Processes involved in phase 1 include determining the research question, identifying eligible CCNDBs, negotiating access to the CCNDB, and ensuring the privacy and confidentiality of subjects. In phase 2 the processes include determining the content of the candidate CCNDBs, assessing the quality of the data in candidate CCNDBs, and determining the technical usability of data in candidate CCNDBs. Phase 3 involves mapping CCNDB data elements to research variables; determining data and record selection criteria; writing and implementing a query to select the desired records; designing a data base and record structure for research variables; performing analytic procedures on the research data; and reporting results of the research. Phases and procedures are discussed in detail in the article.

Representation of everyday clinical nursing language in UMLS and SNOMED.

Everyday clinical nursing language is informal and idiosyncratic. Whether the everyday language of nurses can be represented by standardized vocabulary systems, such as the UMLS and SNOMED, was the focus of the study. Computer systems that allow clinicians to pick terms that are familiar are likely to be better accepted and thus more effective than systems that impose formal terminologies on users. Nursing phrases were extracted from handwritten shift notes, reduced to atomic-level terms, and matched to UMLS and SNOMED. Exact matches were obtained for 56% of terms in UMLS and 49% in SNOMED. Fifty-nine semantic types and 24 different source vocabularies were represented by the terms. Nursing vocabularies were represented by only 5% of source vocabulary citations.

Description of a graduate program in clinical nursing informatics.

This article describes the history and development of the Clinical Nursing Informatics Program at the University of Utah College of Nursing. Program philosophy and curriculum are discussed in the context of the conceptual framework. Courses and student projects are described. The authors reflect on the ensuing stage of program development.

Using large data bases in nursing and health policy research.

Concern about the quality, cost, and outcomes of health care has become a driving force in health policy research. The growing accessibility of large clinical and administrative health care data bases has led to an interest in using such data in health policy research. Clinical data bases are created by providers of care and contain data about episodes and outcomes of care, usually organized as patient records. Administrative data bases contain data about indirect care processes such as insurance claims processing, vital event recording, and quality assurance. Clinical and administrative data bases may contain millions of records, consist of data from multiple sites, and often have missing data issues that must be considered by researchers. These and other characteristics of large data bases require special data manipulation and analytic techniques. Large data bases have been used in epidemiological studies, risk assessment, and technology assessment and to study variations in caregiver practice patterns. Because the use of large data bases by nurse researchers has been constrained by the lack of nursing-relevant data in them, there is a need to reach consensus on useful and feasible nursing data elements and to include those data in ongoing data collection efforts by government agencies and private organizations.

Information seeking by nurses during beginning-of-shift activities.

Information seeking by nurses at the beginning of a work shift is related to planning interventions and other patient activities. Subjects were observed for one hour following morning shift report. The most frequent type of information sought was medication schedules and other information related to medications. On average, nurses spent one-quarter of the first hour after shift report looking for and retrieving information. Nursing information, such as assessments and nursing summaries, required more time to retrieve than other types of information. Findings are compared to earlier research about nurses' information seeking.