Continuing challenges for computer-based neuropsychological tests

A number of issues critical to the development of computer-based neuropsychological testing systems that remain continuing challenges to their widespread use in occupational and environmental health are reviewed. Several computer-based neuropsychological testing systems have been developed over the last 20 years, and they have contributed substantially to the study of neurologic effects of a number of environmental exposures. However, many are no longer supported and do not run on contemporary personal computer operating systems. Issues that are continuing challenges for development of computer-based neuropsychological tests in environmental and occupational health are discussed: (1) some current technological trends that generally make test development more difficult; (2) lack of availability of usable speech recognition of the type required for computer-based testing systems; (3) implementing computer-based procedures and tasks that are improvements over, not just adaptations of, their manually-administered predecessors; (4) implementing tests of a wider range of memory functions than the limited range now available; (5) paying more attention to motivational influences that affect the reliability and validity of computer-based measurements; and (6) increasing the usability of and audience for computer-based systems. Partial solutions to some of these challenges are offered. The challenges posed by current technological trends are substantial and generally beyond the control of testing system developers. Widespread acceptance of the "tablet PC" and implementation of accurate small vocabulary, discrete, speaker-independent speech recognition would enable revolutionary improvements to computer-based testing systems, particularly for testing memory functions not covered in existing systems. Dynamic, adaptive procedures, particularly ones based on item-response theory (IRT) and computerized-adaptive testing (CAT) methods, will be implemented in new tests that will be more efficient, reliable, and valid than existing test procedures. These additional developments, along with implementation of innovative reporting formats, are necessary for more widespread acceptance of the testing systems.

Molecular computing revisited: a Moore's Law?

Moore's Law states that the processing power of microchips doubles every one to two years. This observation might apply to the nascent field of molecular computing, in which biomolecules carry out logical operations. Incorporation of new technologies that improve sensitivity and throughput has increased the complexity of problems that can be addressed. It is an ultimate goal for molecular computers to use the full potential of massive parallelism.

Six-year trends in laboratory computer availability

CONTEXT

Failure of a clinical laboratory computer system can disrupt work flow and charge capture and affect patient care. The first comprehensive survey of computer downtime was conducted in 1995 and demonstrated significant interinstitutional variation in system availability. Despite numerous changes in the laboratory and computer industries since 1995, no follow-up study has been reported.

OBJECTIVES

To quantify current laboratory computer availability and compare it with 1995 performance.

DESIGN

Ninety-seven laboratories prospectively recorded the frequency and duration of computer downtime during 30 days in 2001. Results were compared with 1995 survey data.

RESULTS

For the median facility, the number of downtime episodes decreased from 8 events per 30 days during 1995 to 3 events per 30 days during 2001 (P <.01). The frequency of unscheduled downtime also improved, from a median of 2 to 0.5 events per 30 days (P <.01). Reduced downtime events were paralleled by reduced cumulative downtime (14.3 vs 4.0 hours per 30 days; P <.01). Improvements were not restricted to the median facility; laboratories performing in the bottom quartile in 2001 recorded substantially less downtime than laboratories in the bottom quartile in 1995. When the comparison was restricted to the 37 institutions that participated in both the 1995 and 2001 surveys, a significant reduction in overall downtime and unscheduled downtime events was still evident (P <.01). More recent installation of vendor software patches was associated with a reduced frequency of downtime events in the 2001 data set.

CONCLUSION

Laboratory computer downtime was less frequent in 2001 than in 1995; industry performance appears to be improving.

From pharmacovigilance to pharmacoperformance

The pharmaceutical industry is going through a period of enormous upheaval, as new sciences, technologies and commercial pressures reshape the way in which it performs research and development. PwC Consulting estimates that the top 20 companies will each need to launch between four and six times the number of drugs they currently produce, as well as improving the quality of those drugs, merely to maintain shareholder returns. This has huge implications for pharmacovigilance departments. More drugs means more trials, more patients and -- of course -- more safety reports for evaluation. The pharmacovigilance teams in most big companies are ill prepared for this transition being already stretched to the limit. But as demand for patients to participate in clinical trials increases -- with shorter development times, higher success rates in discovery and greater productivity -- so companies with a poor reputation for safety will suffer. What is it then that companies should be doing to remain compliant and be seen to be safe in the eyes of the consumer? Can pharmacoepidemiology support both molecules in the marketplace as well as those in research and development and what is really needed to enable this? Key to success will be the ability to capture, analyse and evaluate data (from disparate sources) in real time and to make rapid decisions on the appropriate course of action. Putting better structures, processes and technological platforms in place to cope with a big increase in throughput is only a short-term solution yet is it enough to fulfil the objective in the long-term of ensuring compliance and patient safety?

Small bits to big bites

The Department of Clinical Neurophysiology in Uppsala, Sweden, has reached a high degree of computerization. Patient booking, administration, recording equipment, reporting, and telemedicine are linked components forming an integrated laboratory. Today's configuration is a result of the continuous development and implementation of new technologies. During the 1960s and 1970s, the focus was set on the development of signal analysis procedures. The introduction of personal computers and a local network was the main interest during the 1980s. The 1990s were devoted to the Internet and the development of Keypoint electromyography/evoked potential equipment.

Promise and challenge of high-performance computing, with examples from molecular modelling

Computational modelling is one of the most significant developments in the practice of scientific inquiry in the 20th century. During the past decade, advances in computing technologies have increased the speed of computers by a factor of 100; an increase of a factor of 1000 can be expected in the next decade. These advances have, however, come at a price, namely, radical change(s) in computer architecture. Will computational scientists and engineers be able to harness the power offered by these high-performance computers to solve the most critical problems in science and engineering? In this paper, we discuss the challenges that must be addressed if we are to realize the benefits offered by high-performance computing. The task will not be easy; it will require revision or replacement of much of the software developed for vector supercomputers as well as advances in a number of key theoretical areas. Because of the pace of computing advances, these challenges must be met by close collaboration between computational scientists, computer scientists and applied mathematicians. The effectiveness of such a multidisciplinary approach is illustrated in a brief review of NWCHEM, a general-purpose computational chemistry code designed for parallel supercomputers.

Info tech's next step. What's driving the race to market this new generation of clinical systems?

A new generation of clinical IT systems has hit the market all at once. Is this vigorous competition vendor driven, or has health care--and the technology needed to support it--fundamentally changed? And what does it all mean for hospitals struggling to decide where to spend the big bucks it takes to remain technologically viable?

[Image fusion, virtual reality, robotics and navigation. Effects on surgical practice]

In the new minimally invasive surgical era, virtual reality, robotics, and image merging have become topics on their own, offering the potential to revolutionize current surgical treatment and assessment. Improved patient care in the digital age seems to be the primary impetus for continued efforts in the field of telesurgery. The progress in endoscopic surgery with regard to telesurgery is manifested by digitization of the pre-, intra-, and postoperative interaction with the patients' surgical disease via computer system integration: so-called Computer Assisted Surgery (CAS). The preoperative assessment can be improved by 3D organ reconstruction, as in virtual colonoscopy or cholangiography, and by planning and practicing surgery using virtual or simulated organs. When integrating all of the data recorded during this preoperative stage, an enhanced reality can be made possible to improve intra-operative patient interactions. CAS allows for increased three-dimensional accuracy, improved precision and the reproducibility of procedures. The ability to store the actions of the surgeon as digitized information also allows for universal, rapid distribution: i.e., the surgeon's activity can be transmitted to the other side of the operating room or to a remote site via high-speed communications links, as was recently demonstrated by our own team during the Lindbergh operation. Furthermore, the surgeon will be able to share his expertise and skill through teleconsultation and telemanipulation, bringing the patient closer to the expert surgical team through electronic means and opening the way to advanced and continuous surgical learning. Finally, for postoperative interaction, virtual reality and simulation can provide us with 4 dimensional images, time being the fourth dimension. This should allow physicians to have a better idea of the disease process in evolution, and treatment modifications based on this view can be anticipated. We are presently determining the accuracy and efficacy of 4 dimensional imaging compared to conventional evaluations.

Emerging communication technologies in emergency medical services

Advances in communication technologies are changing the face of emergency medical services (EMS). Two communication technologies in particular--cellular-enhanced 9-1-1 service and automatic crash notification (ACN)--will have a considerable impact on EMS. Although enhanced 9-1-1 service from land-line phones is now available in nearly every EMS system across the country, enhanced 9-1-1 service from cell phones currently does not exist. With more and more emergency calls made from cell phones, the implementation of this service is a clear priority. Automatic crash notification, a quickly emerging technology, can potentially provide EMS systems with invaluable data within seconds of when a collision occurs. However, many issues with regard to ACN systems need to be addressed, including liability concerns, access to ACN data, ability of drivers to understand the ACN system, and ACN system architecture. The potential interfaces between ACN systems and EMS systems create significant opportunities to enhance EMS resource management and care of patients involved in motor vehicle crashes. With both cellular-enhanced 9-1-1 and ACN in their infancy, EMS physicians and administrators have a valuable opportunity to provide leadership in the development of these services.

Compassion meets the computer age

Computers get smarter and smarter, but they'll never replace human caring. View the nature of compassion and its unique role in nursing, as well as our challenge to measure the abstract quality. The surprising revelation: Computers are our best bet.