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CIN: Computers, Informatics, Nursing's publisher, Lippincott Williams & Wilkins, has revised its requirements for electronic art submitted with manuscripts, as follows:


"Authors have the option of submitting artwork electronically using the following guidelines. High-resolution, camera-ready images may be submitted electronically as either a Tagged Image File Format (TIFF) or an encapsulated PostScript (EPS) file in Adobe Illustrator(R), Adobe Photoshop(R), or QuarkXPress(R). Please save files in both the application in which they were created (ie, Adobe Illustrator(R)) and as either EPS or TIFF files. Use computer-generated lettering. Do not use screens, color, shading, or fine line.


"The publisher cannot accept art that has been photocopied, is embedded in a Word document (has a .doc extension), was downloaded straight from the Internet or as a screen shot, is supplied in .JPEG or .GIF formats, or was created in Pagemaker or Powerpoint. A laser proof must accompany art that is being submitted electronically.


"If art is more than one color, each figure must be saved in its own file with registration marks and trapping. At the present time, CIN uses black and white artwork only, and authors are encouraged to supply graphics in black and white or grayscale."


Art submitted to CIN electronically must be at least 300x300 dots per inch (dpi) to be properly rendered during publication. Screen shots and downloads from the Internet (and intranets) are not acceptable because material is rendered at 72 dpi; however, the CIN editorial office has developed a procedure for converting screen shots to a format acceptable to the publisher. If you would like guidelines on how to submit screen shots as electronic art, please contact the editorial office at



The field of medical informatics has been established in Cuba since the early 1970s. Cuba's 14 medical schools, spread throughout the country, all have their own faculty of medical informatics.


The Fourth Congress of Medical Informatics of Havana was held at the Havana Convention Palace, Cuba, on March 20-21, 2003, as part of the larger Informatica 2003, which also featured conferences dealing with software, telecommunications, information technology in education, and many other fields. The event was notable for its specific nursing informatics arena.


While most of the speakers and attendees at the medical and nursing informatics events were from Cuba, a significant number attended from other Latin American and Caribbean countries, and keynote speakers included Professor Ed Hammond, President of the American Medical Informatics Association, and Dr Lincoln de Assis Moura Jr., President of the Latin America and Caribbean group of the International Medical Informatics Association (IMIA-LAC). Two UK nurse informaticians, Professor Denis Anthony and Dr Peter Murray, also presented several papers at the conference. Denis' presentations centered on his work on online courses for nurses and therapists in the UK, including an online tissue viability course, while Peter presented papers on e-learning related to nursing practice, and on the potential for open source software within nursing.


Other presentations within the nursing conference focused mainly on the development of software to assist nurses in education and practice. The medical informatics event included sessions on bioinformatics, mathematical modeling, artificial intelligence applications in medicine, and distance education.


Our visit also provided the opportunity to find out more about the Cuban health system and the history and current state of health informatics, and to meet with colleagues from their medical informatics and nursing groups. Cuba is keen to develop nursing informatics as a specific discipline, and has an interest in more general nursing developments. It is hoped that the contacts made by the international speakers at the event will lead to collaborative ventures to assist in both areas.


It is anticipated that the next event in the series will be held in Havana in 2005, and will feature both a stronger nursing presence and more international speakers.


Contributed by Peter J. Murray, RN, PhD, CompBCS



It is a sign of a discipline coming of age when milestones such as the 20th annual event are achieved. A number of events have reached this milestone in recent years, and the 20th annual exhibition and conference in the HC series, HC2003, was held at the Harrogate International Conference Centre, Harrogate, UK. This event is the largest and most comprehensive annual health informatics event in Europe. The conference, which this year was the largest ever, with over 1200 delegates, is organized by the British Computer Society Health Informatics Committee (BCS HIC). The exhibition is organized by BJHC Ltd., and this year attracted over 200 exhibitors, including Cerner, Oracle, McKesson, Cisco Systems, and Hewlett-Packard, spread over 5 large halls. The coordination of the whole event is overseen by an Executive Committee comprising representatives of the conference and exhibition organizers.


The UK is at present in something of a "waiting game" in the implementation of information technology (IT) in the health services. Considerable funding has been promised by the government, and a Director General of NHS Information Technology (or "IT Czar") has been appointed. At present, the precise nature of many of the procurement processes and other aspects of the proposed national systems and solutions has still to emerge from consultation processes. One of the main planks of the new infrastructure being developed will be a national system of electronic health records, although recognizing the interfaces between primary care and hospital-based care, and between healthcare and social care, they are now being called Integrated Care Records Service (ICRS).


With the title "From Information Strategies to Health Solutions," the conference included the familiar range of keynote speakers, peer-reviewed papers, and sessions organized by BCS Health Informatics Specialist Groups and other organizations. In addition, panel discussions, tutorials, master classes, and demonstrations were included on a range of issues to provide variety of presentation styles that would be more suited to some of the topics covered. The BCS Nursing Specialist Group (NSG) session, titled "e-Learning in the Health Community" included presentations on the potential of online communities of practice to assist nurses in their education and practice, on NHSU, the National Health Service's developing corporate university, and on regionally based learning networks to support clinicians' development of health informatics in their practices.


Apart from the NSG session, nursing and nursing informatics were again, as in many recent years, not overly visible in the conference, with few nursing-specific papers. HC2004 will be held in Harrogate on March 22-24 and titled "Delivering Health Informatics at the Point of Care." The call for submissions closes on October 13, 2003, and information is available from


Contributed by Peter J. Murray, RN, PhD, CompBCS



In March, the US Food and Drug Administration (FDA) proposed a rule titled, "Bar Code Label Requirements for Human Drug Products and Blood," aimed at reducing medication errors. The rule would apply to all prescription and some over-the-counter drugs and vaccines. At a minimum, the system would contain the drug's National Drug Code number, which uniquely identifies the drug, its strength, and its dosage form (eg, 10-mg capsule). The proposed rule would also cover blood and blood components.


Hospitals would be required to give patients a bar-coded identification bracelet to link the patient to his or her computerized medical record, and would use bar code scanners or readers that are linked to the hospital's computer system of electronic medical records.


Before a healthcare worker administers a drug to the patient, the healthcare worker scans the patient's bar code and the drug(s) that the hospital pharmacy has provided to be administered. This scan informs the computer which drug is being administered, by referring to the drug's National Drug Code number. The computer then compares the patient's record to the drug's bar code to ensure that they match what has been prescribed.


If there is a problem, such as wrong dose, wrong drug, or wrong time to administer, or the patient's chart and prescriptions have been changed, the computer sends an error message, and the healthcare worker investigates the problem.


The FDA hopes that the bar coding system will cut down on medication errors and ensure more accurate medical records. However, a study published in the Journal of the American Medical Informatics Association, January 2003, by researchers at Ohio State University (OSU) found that, in practice, such a system was "generally successful," but there were serious negative consequences of the shift.


The researchers, from OSU's Institute of Ergonomics, tracked 26 nurses at a Veterans' Administration hospital as they used the Bar Code Medication Administration system, and documented the following issues:


* Sometimes the computer automatically deleted medications from a patient's prescription list, particularly if the patient had been away from his or her bed (for example, to undergo tests in another part of the hospital) and the window of time allotted for administration had closed.


* Doctors reviewed patients' medication orders less often, because it was more difficult or time-consuming by computer than by simply reading the nurses' notes on a paper medical chart. Thus, staff were less likely to know if a patient's medication needed to be changed.


* During busy times, nurses had to work around required procedures, such as manually entering drug and patient codes if the scanner did not read the bars properly.


* Nurses were required to explain why medications were even a few minutes late or early, and became anxious about delivering medications on time, fearing this would reflect on job performance.


* Unusual dosage orders, such as gradually increasing or decreasing amounts over a period of days, presented a problem. Pharmacists had to enter 14 separate daily doses for a patient whose medicine was supposed to taper off over a 2-week period.



The researchers stressed that any system will require "constant maintenance and flexible redesign after implementation," and are helping to create the next version of the software, which will address the issues identified in the previous study. Future studies will examine the use of the BCMA in different hospital departments, and personal digital assistants versus laptop computers as user interfaces with the barcode system.


For more information on the FDA's proposal, visit


REFERENCE:Patterson ES, Cook RI, Render ML. Improving patient safety by identifying side effects from introducing bar coding in medication administration, J Am Med Inform Assoc. 2002; 9 ( 5 ): 540-553.





NANDA-International has issued a call for abstracts for the Second Biannual NNN Conference in March 2004. Areas of focus for the conference include classification development, critical thinking, informatics, networking, research, use in practice, use in education, and linking or integrating nursing language; papers and presentations on these topics will be given precedence in acceptance.


Abstract submissions are due electronically by September 8, 2003; submission status and presentation scheduling will occur in November. The lead author will receive a letter of acceptance and a speaker packet by December 15, 2003.


For more information and complete submission guidelines, visit





Hand-held computers and personal digital assistants (PDAs) are being used for more than calendars and phone directories, especially in the area of clinical research coordination. The use of PDAs for study site management is evolving, but currently individually custom designed by the user. A survey at the PDA Cortex Web site, authored by Carolynn J. Thomas, MSPH, RN, Donna Fowler, BSN, RN, and Yvonne Stolworthy RN, BScN, CCRP, aims to determine the use and application of PDAs in the operation and management of clinical trials at the research site level.


The information collected in this survey will be used for an article to be published in an international research journal. To take the survey, visit





The Web site of the Special Interest Group on Nursing Informatics of the International Medical Informatics Association (IMIA-NI), the global body for nursing informatics, was recently redesigned, and updated material and functionality has been added to the site. It is firmly established at its new URL,


The group invites visitors and comments on the redesign, and asks Webmasters to update pertinent links.




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