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Toronto, Ontario, hosted the 24th Annual International Nursing Computer and Technology Conference last May 25 to 28, 2006. The conference was sponsored by The State University of New Jersey Rutgers College of Nursing, in collaboration with the University of Ontario Institute of Technology (UOIT). Full-day preconferences were held at UOIT, where participants had a chance to learn more about using human patient simulators. Postconferences examined multiple media materials for different learning styles, telehealth, and strategies to increase mobile learning.


If one were to summarize the conference, using the words of the closing speaker, Dr Scott Erdley, one would say that the focus was sophisticated dolls and podding. Although presenters addressed many other topics related to nursing, technology, and education, from the opening speaker to the end speaker, these two subjects were a common theme. The sophisticated dolls, or human patient simulators, were a feature of the opening keynote by Dr Carolyn Byrne, Dean Faculty of Health Science at the UOIT. In her address, entitled "Creating a State of the Art Technology Environment for Nursing," Dr Byrne pointed out that technology in education is only a tool for learning and does not obviate a caring curriculum. In the UOIT nursing program, students learn many clinical skills using human patient simulators that are programmed to provide real-life situations. The students are videotaped during simulations so they can be debriefed and they can critique their own performances.


All students and faculty at UOIT are required to have laptops. They receive a new laptop every 2 years and software updates every 12 months. Students pay $1500 a year for the laptops, which they can purchase for $1 at the end of their program. Although the students do complain about the cost, they all agree that they will benefit in the long run because they will be comfortable using computers as a multipurpose tool. As a new program (it is only 3 years old), it was perhaps easier to implement this requirement than in an existing program. Nevertheless, it required faculty buy-in and training. This was accomplished by providing training 1 day a week for a term as well as a summer semester that focused on technical training and professional development in teaching and the development of curriculum. Dr Byrne emphasized the need for a solid infrastructure, including a help desk and classroom design that provides for the use of technology.


Training students was also necessary. To determine the amount of training needed, the UOIT surveyed incoming students regarding their current computer skills. Although UOIT expected a regular bell curve, with most students somewhat competent, what they found instead was a bimodal curve, with many students being almost beginners while an equal number were somewhat experienced. The UOIT also found that some students have poor writing skills and most need to be reeducated on how to search beyond Google and how to critique evidence. The UOIT is also experimenting with having students use personal digital assistants in the clinical area, and has found that the group of students with personal digital assistants made fewer errors than did those without. One student described the personal digital assistant as "having a brain in the pocket."


The second keynote address by Dr Wendy M. Nehring furthered the participants' knowledge on the use of simulations. She addressed the problem of students continuing their learning from the school in the clinical area and asked how we can select what to teach so that students can learn what there is no time to teach. She also presented the results of her survey on state boards of nursing requirements allowing the use of high-fidelity simulations as a solution for the shortage of clinical settings. She found that 16 states allowed the use of simulations in place of clinical hours but did not specify percentages. Some replied that they did not specify clinical hours at all but instead required schools to meet their criteria. High-fidelity simulations have made an impression on California, who replied that future regulations would require the use of these simulations for clinical hours. Texas replied that this requirement was under consideration.


The level of clinical simulation, which has a place in nursing education, varies greatly, from that of Mrs Chase, a full-body, low-tech mannequin, through task trainers such as the IV arm, to role playing with standardized patient actors, to the new gold standard, high-fidelity electronic patients that can be programmed to simulate disease and emergency conditions. The use of the latter in critical care courses and critical incident nursing management greatly improves learning while not endangering patients. These simulations also allow for debriefing, during which the learners can reflect on what they were thinking during the crisis, and learning how to improve their responses to similar incidents. Dr Nehring stressed the importance of the debriefing. Supporting the use of simulations, the literature has reported that test scores on the NCLEX increase with student simulation experience. Several healthcare professional organizations such as the Oregon EMS Board and the Canadian respiratory therapists require that candidates demonstrate their clinical competencies in simulated clinical environments. Dr Nerhring led the participants to wonder whether the US and Canadian Boards of Nursing will require such testing in the future.


Several of the concurrent presentations addressed other aspects of simulations. One by Drs Suzanne Beyea and Linda Kobokovich provided information on their use of human patient simulations to develop recent graduate nurse competency as part of their nurse residency program. In another presentation, information on the National League for Nursing Laerdal Simulation Program was presented by Dr Mary Anne Rizzolo. After the first conference day, a welcoming reception, where many spontaneous discussions on clinical simulations occurred, was sponsored by Laerdal Medical. Networking was the order of the evening, as was visiting the exhibitions.


Joyce Sensmeier addressed the topic of creating value through innovation and informatics, the management of information. She provided information on the many different roles of nursing informatics specialists, including project manager, consultant, educator, researcher, and product developer, and delineated emerging roles in this specialty that include entrepreneur, business owner, and chief information officer. Ms Sensmeier reported on the results of a Healthcare Information and Management Systems Society survey of acute care nurses on the impact of health information technology (HIT) on nursing. They found that nurses believe that HIT facilitates interdisciplinary patient centered communication and that critical events can be effectively managed using HIT. Quoting President Bush, who in 2004 said that "most Americans will have electronic health records within the next 10 years," she delineated six major drivers for healthcare providers to implement HIT: flat or declining reimbursement with rising overhead costs; compliance with regulations, such as that of HIPAA and JCAHO; technology and knowledge advancements; physician and nurse retention and productivity; pressures from healthcare purchasers, such as pay for performance; and consumer demands for choice, control, and communication. Two barriers to the implementation of HIT are the lack of standardization of terminology and the interconnectivity between different systems. The Healthcare Information Technology Standards Panel, a cooperative partnership between public and private sectors, has been set up to guide, inform, and enable the standards harmonization process to provide the interoperability of systems. The goal is the establishment of a nationwide health information network for the United States.


Ms Sensmeier also outlined the background and vision of the Technology Informatics Guiding Educational Reform project. Arising from the concern that nursing representation was missing from national efforts toward the electronic health records, this group was formed in autumn 2004 with a vision that includes expanding collaborations across nursing groups, interweaving technologies into practice and education, bridging the gap between education and practice, and implementing evidence-based practice. The Technology Informatics Guiding Educational Reform group is planning an invitational summit this fall to further their agenda. Invitees are from nursing organizations and governmental agencies. The goal of the meeting is a published report with an action plan. Ms Sensmeir closed with the reminder that it requires togetherness to both advance the national agenda and ensure better delivery of healthcare in the US.


Besides more than 40 concurrent sessions that made selecting one to attend very difficult, there were 47 posters, each of which would have made a good conference presentation. Several posters focused on different aspects of using personal digital assistants as well as distance education, telehealth, collaboration, using simulations, and evaluating students with technology.


The final keynote speaker, Dr Scott Erdley, let us all have a glimpse of the future as he looked at technology in the year 2010. One of his points was that nursing needs to be proactive, not reactive. He compared the past, present, and future in education, practice, and research. The educational past revolved around brick and mortar buildings and teaching passive students, whereas today, active learning, learner initiative, and distance education are becoming more the norm. He predicted that the future will hold more asynchronous education and an emphasis on mobility. In clinical practice, the past involved large wards, high paperwork, and pen and paper. The present has not yet changed much, but the future can hold care that is patient centric and caring integrated with technology and less paperwork. Research both in the past and present involved structured experimentation and observation. However, with the advent of the electronic health record and standardization of nursing documentation, the future can present us with the ability to continuously collect data that will provide evidence-based practice without boundaries.


The future, however, was already present at the conference. Drs Erdley and Maag did the first vodcast (video plus audio) with interviews of three participants at a nursing conference. Several conference sessions were also blogged and podcasted immediately at the end of the sessions to Visit the site (it is free) to see a detailed reporting of presentations on podcasting, social support through online journals, and the Toronto telehomecare project. Others involved in podcasting and vodcasting at this conference were Dr Peter Murray and Bill Perry, MA, RN. It is hoped that other nursing conferences will take the opportunity to use the blogging, podcasting, and vodcasting technology to provide information to those who are unable to attend a conference.


Contributed by


Peter J. Murray, PhD, RN


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The Clinical Informatics Wiki, or ClinfoWiki, is an implementation of a wiki devoted to topics in clinical informatics. There are currently more than 100 articles at the site, and help is needed to complete this study of Clinical Informatics.


A wiki is a type of Web site that allows users to easily add, remove, or otherwise edit all content quickly and easily, sometimes without the need for registration. This ease of interaction and operation makes a wiki an effective tool for collaborative writing. The term wiki can also refer to the collaborative software itself (wiki engine) that facilitates the operation of such a Web site or to certain specific wiki sites, including the computer science site (and original wiki), WikiWikiWeb, and the online encyclopedia Wikipedia. When used to refer to a specific site, wiki is often capitalized.


The word wiki is a shorter form of wiki wiki (pronounced "weekie weekie"), which is from the native Hawaiian language; it is commonly used as an adjective to denote something "quick" or "fast."


The first wiki, WikiWikiWeb, is named after the "Wiki Wiki" line of Chance RT-52 buses in Honolulu International Airport. It was created in 1994 and installed on the Web in 1995 by Ward Cunningham, who also created the Portland Pattern Repository.


Wiki is sometimes interpreted as the "backronym" for "What I know is," which describes the knowledge contribution, storage, and exchange function.


In technical terms, a wiki is a simplification of the process of creating HTML pages combined with a system that records each individual change that occurs over time so that at any time, a page can be reverted to any of its previous states. A wiki system may also include various tools designed to provide users with an easy way to monitor the constantly changing state of the wiki and a place to discuss and resolve many inevitable issues, specifically disagreement over wiki content.


Wiki content can also be misleading because users are bound to add incorrect information to the wiki page. Many wikis allow completely unrestricted access so that people are able to contribute to the site without registration, contrary to the requirements of various other types of interactive Web sites, such as Internet forums or chat sites. In a recent study published by the journal Nature, experts' analysis of articles published by Wikipedia and Encyclopedia Britannica found a comparable level of accuracy between the two sources, but Wikipedia founder Jimmy Wales acknowledged the lack of expert participation in article writing and review and is currently seeking experts' contributions to content.


To contribute to the ClinfoWiki by beginning a new article or editing an existing article, you must first create an account and log in. The site's home page, Main_Page, gives an overview of the project and provides links to documentation on customizing the interface and the user's guide for usage and configuration help. Once an article has been posted, edits can be tested in the Sandbox.


Topic areas for the ClinfoWiki currently include the following:


* Electronic medical record systems


* Computer-based provider order entry


* Clinical decision support


* Personal health records


* Blueprint for a comprehensive HIT system


* Biobanking-also known as biorepositories or tissue banks


* Regional health information organizations


* Evidence-based medicine


* US Federal Health Information Technology Initiatives


* The E-patient-provider relationship


* Interface terminology


* International views


* Blogposium, April 2006


* Endowed professorships and chairs in health/medical/nursing/biomedical informatics


* External links



Created in July 2005 by Dean F. Sittig, PhD, ClinfoWiki's purpose is to provide clinical informaticists from around the world a place to document and discuss lessons learned from day-to-day activities. Sittig hopes that whenever possible, real evidence will support assertions, but for the time being, his goal is simply to have informatics knowledge already gained written down in a form that others can use.



A team of researchers at the Indiana University School of Informatics is designing a tool to distinguish between fake and real papers.


Called the Inauthentic Paper Detector (IPD), the tool uses compression algorithms to determine whether technical texts are generated by a machine whose intent is to deceive or by humans.


"This is a potential problem since no existing systems, the Web for example, can or do discriminate between content that is meaningful or bogus," says assistant professor Mehmet Dalkilic, a data mining expert. "We believe that there are subtle, short- and long-range word or even word string repetitions that exist in human texts, but not in many classes of computer-generated texts, that can be used to discriminate based on meaning."


Joining Dalkilic on the IPD project are assistant professor Predrag Radivojac; informatics doctoral student James Costello; and Wyatt T. Clark, who will be graduating in May with a bachelor's degree in informatics.


The IPD system is based on a combination of compression algorithms, computing tools that reduce the size of data to save space or speed transmission time.


To begin their study, the team identified two kinds of texts they would analyze: authentic text is a collection of several hundreds or thousands of syntactically correct sentences such that the text as a whole is meaningful. Inauthentic text is a collection of several hundreds of thousands of syntactically correct sentences that, as a whole, have no meaning.


The Indiana University researchers' work, Using Compression to Identify Classes of Inauthentic Texts, was presented at the Society for Industrial and Applied Mathematics Conference on Data Mining, April 20 to 22, 2006, in Bethesda, MD.


The informatics study was inspired by a prank pulled by three Massachusetts Institute of Technology students who, in 2004, developed a computer program that churned out randomly generated fake computer science language, essentially a four-page compilation of gibberish. They submitted it as a research paper to an international conference on computer science and informatics, and it was accepted without review.


Radivojac, whose research expertise is machine learning, says the IPD easily detected numerous inauthentic technical papers tested, including the Massachusetts Institute of Technology students' spurious submission.


In general, identifying meaning in a technical document is difficult, Dalkilic says. "We don't claim we have found a way to distinguish between meaning and nonsense, but we do emphasize that there are many nontrivial classes of inauthentic documents that can be easily distinguished based on compression algorithms."


Costello's and Clark's involvement in the IPD project earned them travel expenses to the Society for Industrial and Applied Mathematics 2006 Conference, on Data Mining compliments of the Lawrence Livermore National Laboratory in California.


To see how the IPD works, visit its Web site at



According to a new national study released in May 2006 by the Kaiser Family Foundation, electronic media is a central focus of many very young children's lives, used by parents to help manage busy schedules, keep the peace, and facilitate family routines such as eating, relaxing, and falling asleep. Many children live in heavy-media households where television (TV) is turned on throughout the day, during meals, and in bedrooms, and TVs are put in children's bedrooms so family members can watch their own shows. Many parents also express satisfaction with the educational benefits of TV and how it can teach positive behaviors.


The report "The Media Family: Electronic Media in the Lives of Infants, Toddlers, Preschoolers, and Their Parents" is based on a national survey of 1051 parents with children aged 6 months to 6 years and a series of focus groups across the country.


According to the study, in a typical day, more than 83% of children younger than 6 years old use screen media, with those children averaging about 2 hours a day. Media use increases with age, from 61% of babies 1 year or younger, who watch an average of 1 hour and 20 minutes of screen media in a typical day, to 90% of 4- to 6-year-olds, who average 2 hours and 3 minutes per day.


One in three children this age has a TV in the bedroom: 19% of children 1 year or younger, 29% of children aged 2 to 3 years, and 43% of those 4 to 6 years old. The most common reasons parents gave for putting a TV in a child's bedroom is to free up other TVs in the house so the parent or other family members can watch their own shows (55%), to keep the child occupied so the parent can do things around the house (39%), to help the child fall asleep (30%), and as a reward for good behavior (26%). As one mother who participated in a focus group in Irvine, CA, said, "Media makes life easier. We're all happier. He isn't throwing tantrums. I can get some work done."


A third of these homes reported that the TV is turned on all (13%) or most (19%) of the time. A similar proportion (30%) reported that the TV is turned on during meals all (16%) or most (14%) of the time. As a focus group mother from Columbus, OH, explained, "The TV is on all the time. We have five TVs. At least three of those are usually on-her bedroom, the living room, and my bedroom."


Children whose parents have established these heavy TV environments spend 25 to 30 minutes more watching TV per day than do other children.


At a time when there is great debate on the merits of educational media for children, 66% of the parents surveyed said that their children imitate positive behavior from TV, such as sharing or helping, whereas 23% said that their children have imitated aggressive behavior, such as hitting or kicking. Older boys are more likely to imitate aggressive behavior from TV (45% of 4- to 6-year-old boys). More than half (53%) of the parents reported that TV tends to calm their children, whereas 17% said that TV makes their children excited. A majority (69%) said computers mostly help children's learning; 38% said the same about watching TV, whereas 31% said TV "mostly hurts" and 22% said it does not have much effect.


The following are additional key findings from the survey.


Media in the Bedroom

Participants reported that 11% of all children in the survey spend half or more of their TV-watching time watching in the bedroom, and 12% of all children go to bed with the TV turned on half of the time or more.


Children Less Than 2 Years Old

More than 43% of children younger than 2 years old watch TV every day, and nearly 18% watch videos or DVDs every day. Most parents of these children (88%) reported that they are in the same room with the child while they are watching TV either all or most of the time.


More than one quarter (26%) of parents with children younger than 2 years old said that their children have never watched TV.


Computer Use-Digital Divide

Of children 6 years old and younger, approximately 78% live in homes with a computer, and 69% have Internet access from home; 29% have more than one computer. Among all children 6 years old and younger, 43% have used a computer, and 27% use a computer several times a week or more. Among children ages 4 to 6, 43% use a computer several times a week or more.


There is a large gap in computer ownership by income and parent education. For example, just over half (54%) of children in lower income households (less than $20 000 a year) have a computer in the home compared with 95% of those from higher income homes ($75 000 a year or more).


Changes in Household Media Environment and Media Use

In the time since a similar survey was conducted in 2003, the number of children in households with at least one computer has increased from 73% to 78%, the number of children in households with Internet access has increased from 63% to 69%, and those with high-speed Internet access increased from 20% to 42%.


There was a small but statistically significant decrease in the percentage of children living in households where the TV is kept on always or most of the time, from 37% in 2003 to 32% in 2005, and of children living in households where the TV is turned on during meals always or most of the time, from 35% in 2003 to 30% in 2005.


The survey is a nationally representative, random-digit-dial telephone survey of 1051 parents of children aged 6 months to 6 years old, conducted from September 12 through November 21, 2005. The margin of sampling error for the complete set of weighted data is +/-3 percentage points. The margin of error for subgroups is higher.


Eight focus group sessions were conducted between March 22, 2005, and March 1, 2006, in four locations: Columbus, OH; Irvine, CA; Denver, CO; and Washington, DC. Each session lasted approximately 2 hours and was moderated by a Kaiser Family Foundation staff member. There were generally eight participants in each group. Participants were recruited to the sessions by an independent research firm, and two types of focus groups were conducted: one with mothers of children between the ages of 1 and 3 years and one with mothers of children between the ages of 4 and 6 years. Participants were required to have at least one TV and that the children watched TV, videos, or DVDs at least several times a month. The participants were screened to reflect middle-income families, and at least a third of the participants in each group met criteria reflecting the statistics found in the national survey (ie, a TV in the child's bedroom and older children who played video games and used computers at least several times a month).


The following is a sampling of quotes from the focus groups.


Media makinglife easier as a parent

"If he's watching TV, I can get things done. I don't have to constantly watch him." Mother of a 1- to 3-year-old, Denver, CO.


"My son is really hyper. That's a time when I can get him to actually calm down and watch a little TV[horizontal ellipsis]He will slow down and that helps change his mood[horizontal ellipsis]It's much better for him and for me." Mother of a 4- to 6-year-old, Irvine, CA.


Why parents put TVs in their children's bedrooms

"I did it so I could watch my TV. I also wanted it so he would watch and fall asleep." Mother of a 1- to 3-year-old, Denver, CO.


"My 2-year-old will literally bounce in his crib to the Wiggles. As soon as I turn it off, he lies right down and goes to sleep." Mother of a 1- to 3-year-old, Columbus, OH.


Educational value of media

"He's always telling me what is right and wrong from the things he sees on TV. It's opened doors in being able to talk to him." Mother of a 4- to 6-year-old, Denver, CO.


"I don't spend nearly as much time with my son as I need to[horizontal ellipsis]He has learned huge amounts from the video and computer games we have[horizontal ellipsis]I'm very grateful." Mother of a 1- to 3-year-old, Irvine, CA.


Food advertisements

"They [commercials] really work on my son already. He'll see something in a Burger King commercial. He'll tell me that we have to go to Burger King today. It doesn't matter what we're doing, we have to go." Mother of a 4- to 6-year old, Denver, CO.


"My daughter would eat a cheeseburger from McDonald's everyday if I would let her. She sees it on TV, and she will come to me right away saying that's what she wants for lunch." Mother of a 1- to 3-year-old, Columbus, OH.


General thoughts on media

"It makes life easier now, but in the long run, when they're older and starting to run into all these problems, I think I'll wish I wouldn't have let them do it when they were 5." Mother of a 4- to 6-year-old, Columbus, OH.


"For our little guy, TV time is all of us on the couch together. We'll talk about what's going on. If it's Blue's Clues, we'll answer back. We only do 20 minutes a night." Mother of a 1- to 3-year old, Irvine, CA.


TV content

"For a little while, we weren't really supervising, but then we found him quoting from a movie called Mansquito on the Science Fiction Channel." Mother of a 4- to 6-year-old, Denver, CO.


"I watch CSI[horizontal ellipsis][S]he sits down and watches with me. I don't know how harmful it is to her. It's something gory, but it doesn't seem to bother her. She hasn't had any nightmares from it." Mother of a 1- to 3-year old, Irvine, CA.


The Kaiser Family Foundation is a nonprofit, private operating foundation dedicated to providing information and analysis on healthcare issues to policymakers, the media, the healthcare community, and the general public. The foundation is not associated with Kaiser Permanente or Kaiser Industries.


For more information, visit



Playback of audio and video files, Internet telephony, and video conferencing are applications typically executed on home personal computers. For upcoming versions of K Desktop Environment, which is widely used on Unix and Linux work stations, these tasks will be performed by an updated and fundamentally extended multimedia architecture called Phonon.


Multimedia is still not well supported in most Unix environments, in contrast to other OS platforms, where several multimedia infrastructures are established. However, these models adopt a personal computer-centric approach in which all multimedia processing takes place within a single computer. The network is, at best, used for streaming data transmission.


Because there is a strong trend toward networked multimedia devices such as networked cameras, audio devices, personal digital assistants, cellular phones, and personal computers, centralized approaches are becoming obsolete. Thus, Network-Integrated Multimedia Middleware (NMM) considers the network as an integral part and enables the intelligent use of devices distributed across a network.


This network-integrated multimedia infrastructure will be available through the K Desktop Environment for Linux and in the future for other operating systems. The unified architecture offers a simple and easy-to-use interface for applications to integrate multimedia functionality, such as simultaneous audio and video presentations on all systems connected to the network, and can be used also for ubiquitous computing and mobile computing.


Although the foundations of this architecture were researched at the Computer Graphics Lab at Saarland University in Germany, NMM has been brought to market by a spin-off company, Motama, formed by the university. Because of the close collaboration of Motama with Open Source developers involved in the K Desktop Environment project, first results were presented with a talk and accompanying live demonstration at LinuxTag in Wiesbaden, Germany (May 2006). LinuxTag is known as the largest and most important convention and exhibition for Linux, Free Software (freeware), and Open Source in Europe.


For more information on NMM, visit



Judy G. Ozbolt, PhD, RN, FAAN, has been appointed professor and director of the Nursing Informatics master's program at the University of Maryland School of Nursing. Ozbolt, who is nationally and internationally known for her expertise in nursing informatics, most recently served as a scholar at the Institute of Medicine in Washington, DC. She previously served as the Independence Foundation Professor of Nursing and professor of Biomedical Informatics, as well as the Joe B. Wyatt Distinguished University Professor at Vanderbilt University.


Ozbolt is a fellow of the American Academy of Nursing, president and fellow of the American College of Medical Informatics, and a founding fellow of the American Institute for Medical and Biological Engineering. She was a founding member of the editorial board of the Journal of the American Medical Informatics Association and is currently a member of the editorial board of the Journal of Biomedical Informatics. She also serves as a reviewer for the International Journal of Medical Informatics.


"This is an exciting time to be at the University of Maryland School of Nursing," says Ozbolt. "We will be honing the nursing informatics master's program-the first in the world-to meet the demands for 21st century practitioners. We have a terrific faculty team developing research programs to discover and demonstrate how to use informatics to improve care and outcomes."


Ozbolt holds a PhD/MS and MS from the University of Michigan and a BSN from Duke University.


Founded in 1889, the University of Maryland School of Nursing is one of the leading research institutions in the nation and enrolls approximately 1300 students in its baccalaureate, master's, and doctoral programs and 3000 students in its continuing education programs. The school emphasizes the principles of leadership, partnership, and innovation.