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PURPOSE. This study aims to determine whether a computer-aided nursing (CAN) diagnosis system improves diagnostic accuracy and efficiency. METHODS. A randomized crossover trial was performed using two kinds of case studies with 42 nurses as subjects. The subjects were divided into a group using the CAN diagnosis system and a group using a handbook of nursing diagnosis. Degree of accuracy was judged by using Lunney's seven-point interval scale, while efficiency was evaluated by time required for diagnosis. FINDINGS. There was no significant difference between the two groups in terms of diagnostic accuracy; however, time required for diagnosis was significantly shorter for subjects who used the CAN diagnosis system than for those who did not. Multiple regression analysis showed that the use of the CAN diagnosis system was the only factor associated with the time required for making the nursing diagnosis. CONCLUSIONS. The use of the CAN diagnosis system improved the efficiency of the diagnostic process without reducing the level of accuracy of nursing diagnoses. PRACTICE IMPLICATIONS. The use of a computerized system should be a useful tool for implementation of standardized nursing terminologies. [ABSTRACT FROM AUTHOR]

Abstract: An efficient approach to spirocyclic oxindole architecture with vicinal quaternary carbon centers is described. The reaction of 2-allyloxyindolin-3-ones with cyanomethylphosphonate at low reaction temperature proceeds smoothly with consecutive olefination, isomerization, deacylation, and anion-accelerated Claisen rearrangement to give the 3,3-disubstituted oxindoles with vicinal quaternary all-carbon centers in high yield and diastereoselectivity. The oxindoles are readily converted into more synthetically advanced spiro-products. [Copyright &y& Elsevier]

Summary: A prospective payment system based on diagnosis procedure combination (DPC/PPS) was introduced to acute care hospitals in Japan in April 2003. In order to increase hospital income, hospitals must shorten the average length of stay (ALOS) and increase the number of patients. We constructed a simulation program for evaluating the relationships among ALOS, bed occupation rate (BOR) and hospital income of hospitals in which DPC/PPS has been introduced. This program can precisely evaluate the hospital income by regulating the ALOS and the number of patients for each DPC. By using this program, it is possible to predict the optimum ALOS and optimum number of inpatients for each DPC in order to increase hospital income. [Copyright &y& Elsevier]