No abstract

The impact of the clinical database system SISCOPE on medical services was evaluated and objective data compiled on the quality of information recording and reporting using a fully structured data entry system compared to traditional free text reporting. 1565 upper endoscopy reports produced with SISCOPE over a period of 12 months were assessed for completeness and compared to 152 and 208 free text reports done 4 months before and 1 month after the study period, respectively. Data on four common gastrointestinal findings (esophageal varices, ulcers, polyps and tumors) were evaluated. Physicians' compliance with the new system was good, as reflected by a constant level of quality of reporting over time, although a very slight decline in the ratio of computer generated reports to the total number of examinations was noted. Structured reports had an 18% missing data rate and contained 60% more relevant information than free text reports, which had a 48% missing data rate. No educational effect of the system was seen as missing data rates returned to pre-computerization levels just one month after the end of the study. It is concluded that menu-driven structured data entry systems result in production of far superior reports as compared to free text systems, probably due to their reminder effect.

No abstract

Students' attitudes toward medical informatics were evaluated with self-administered questionnaires, answered by 140 (77%) first-year medical and dental students. Fourteen per cent classified their computer literacy as negligible and 49% as deficient. Ninety-six per cent had used a computer before and 59% used one regularly. Nineteen per cent had computer education in secondary school and a further 16% attended courses given by a computer company. Only 16% read regularly about informatics. These results are similar to those observed in more industrialized countries, except that high-school education is more deficient. To 93% of these students, computer literacy is important for doctors, and to 85% computers may be very useful in many areas of health care. In the opinion of 66% of students, the computer-based patient record will be available within the next 3 to 10 years. Women showed lesser computer literacy (77% computer illiteracy to 39% in men), but there were no relevant differences in attitudes, behaviour and beliefs towards medical informatics between gender, for the same level of computer literacy. Computer education in the undergraduate curriculum was demanded by 92%, and 75% of these preferred an elective course. Weekly hours suggested for lectures should be 1 (54%) or 2 (42%), and for hands-on practice 2 (54%) or 4 (31%) hours. The curriculum should include medical applications (83% of students), information science theory and technology (44%), micro-informatics (44%), bibliographic database search (27%), programming languages (23%) and statistical packages (23%). Gender, computer literacy or course did not correlate significantly with students' opinions about the contents of undergraduate education.

Introduction: Chronic venous insufficiency (CVI) affects a large proportion of individuals and, with the ageing of the Western European population, its prevalence is bound to increase. Epidemiological data, particularly regarding risk factors, are scarce and controversial. Objective: Identification of clinical factors associated with an increase in severity of CVI. Setting: Community-based study of patients presenting to their general practitioner. Methods: Four hundred and seventy-four unselected patients with symptoms suggesting CVI were evaluated by 18 general practitioners. CVI was diagnosed and assessed by clinical examination and portable continuous-wave Doppler. Severity of CVI was graded according to the nomenclature of the International Society for Cardiovascular Surgery. Patient demographic and clinical factors showing a linear relationship with the severity of CVI were analysed with the proportional odds model to evaluate the simultaneous effect of several factors in the severity of CVI. Results: A multivariate model is proposed, where age is a major risk factor for increased severity. Other factors that are independently correlated with the severity of CVI are body weight, environmental heat, sedentarily, CVI in both parents, high-dose oestrogen formulations, osteoarticular disease of the lower limbs, presence of truncal varices, involvement of the internal saphena, lymphoedema and history of thrombophlebitis. Conclusion: Because most studies do not adjust for age when testing for risk factors, this may be an important reason for the multiplicity of reported factors and the lack of consistency of their results.