Douglas Porter

Collection of a clean voided urine specimen: a comparison among spoken, written, and computer-based instructions.

In an effort to compare different methods of instructing patients, 99 women 18-25 years of age were given computer, spoken, weitten, or no instructions for the collection of a clean voided urine specimen. The group who received computer instructions was the most uniform in its performance (P less than 0.002, F-test) and reported the fewest procedural problems (P less than 0.02, Fisher test). In addition, this group had fewer contaminating bacteria than the group who received written instructions (P less than 0.03 , Mann-Whitney test). The group who received no instructions had more bacteria (P less than 0.0001, Mann-Whitney test) than any of the other groups. The effectiveness of the computer instruction was probably related to numerous attributes, including the individualized quality of the dialogue, self-pacing, self-testing, and privacy.

ClinQuery: A System for Online Searching of Data in a Teaching Hospital

We designed a user-friendly computer program that permits physicians to search the clinical database of Bostons Beth Israel Hospital by clinical and demographic descriptors. For example, the user can identify all admissions in which diabetic ketoacidosis was diagnosed, the serum bicarbonate level was under 12 mmol/L, and the length of stay exceeded 7 days. Once particular admissions are identified, all data stored in the computerized record can be displayed. Authorized persons can also request the patients complete medical record for further study. Over a 30-month period, 530 doctors, nurses, medical students, and administrators used the program to search the hospitals clinical database 1786 times. They displayed detailed information on 30,851 patients and requested the complete medical record 5319 times. In 1389 of the 1786 searches completed, the searcher responded to a computer-based questionnaire about motivation for the search. Responses indicated that 32% of the searches were for clinical research, 17% for patient care, 17% for teaching and education, 11% for hospital administration, and 12% for general exploration. In 58% of the searches, respondents indicated definite or probable success in finding the desired information. We conclude that physicians and allied personnel will repeatedly obtain, view, and analyze aggregate clinical information if they are provided with appropriate tools. We believe that such access to clinical information is an important resource for patient care, teaching, and clinical research.

Computer Searching of the Medical Literature

Excerpt To The editor: A study by Haynes and colleagues (1) published last year inAnnalsdrew conclusions that appear to be invalid. These conclusions were presented again in a recent article (2). T...

The relationship of headache occurrence to barometric pressure

A total of 75 people residing in the metropolitan Boston area who had frequently recurring headaches kept a headache diary for one month beginning March 1975. Data were also collected about barometric pressure during this time. We found that the probability of headache severity on any day was independent of the effects of time. An inference of this, supported by other findings in this study, is that headache occurrence is minimally affected by time-related phenomena such as barometric pressure readings or changes..

Self-service computerized bibliographic retrieval: a comparison of colleague andpaperchase, programs that search the MEDLINE data base

Colleague and PaperChase are the two most widely used computer systems designed specifically for clinicians and scientists who wish to search the National Library of Medicines MEDLINE data base of references to the biomedical literature. The present study compares the performance of these two systems. Two matched groups of second-year medical students each received 3 hr of instruction, one group in Colleague, the other in PaperChase. Each student then attempted 10 test searches. The next day the groups were reversed, and each student attempted 5 additional searches. During 3 1/2 hr allocated for searching, users of Colleague attempted 64 test searches and retrieved 326 target references; users of PaperChase attempted 78 searches and retrieved 496. Users of Colleague took a mean of 2.2 min and spent a mean of

New Uses of a Large Clinical Data Base

1.20 to find each target reference; users of PaperChase took 1.6 min and spent

Computerized radiologic reporting with voice data-entry.

0.92. We conclude that after limited training, medical students find more references faster and at lower cost with PaperChase than with Colleague.

Dietary interviewing by computer. An experimental approach to counseling.

The clinical and administrative management of patient care requires access to and assessment of increasingly large volumes of data. The clinical information on specific patients that is contained in medical records, such as reports of examinations and laboratory studies, must be supplemented by the accumulated clinical experience contained in journal articles, reference works, and the consultations of skilled colleagues.1 Organized and rapid access to this information is crucial to the quality of patient care.