Biomedical subjects

J J McGowan

Publications and source records attributed to J J McGowan.

At least 19 recordsLinked to original sources

PubMed2006

Organ donation and utilization, 1995-2004: entering the collaborative era.

Continued progress in organ donation will help enable transplantation to alleviate the increasing incidence of end-stage organ disease. This article discusses the implementation and effect of the federally initiated Organ Donation Breakthrough Collaborative; it then reviews organ donation data, living and deceased, from 1995 to 2004. It is the first annual report of the Scientific Registry of Transplant Recipients to include national data following initiation of the collaborative in 2003. Prior to that, annual growth in deceased donation was 2%-4%; in 2004, after initiation of the collaborative, deceased donation increased 11%. Identification and dissemination of best practices for organ donation have emphasized new strategies for improved consent, including revised approaches to minority participation, timing of requests and team design. The number of organs recovered from donation after cardiac death (DCD) grew from 64 in 1995 to 391 in 2004. While efforts are ongoing to develop methodologies for identifying expanded criteria donors (ECD) for organs other than kidney, it is clear DCD and ECD raise questions regarding cost and recovery. The number of living donor organs increased from 3493 in 1995 to 7002 in 2004; data show trends toward more living unrelated donors and those providing non-directed donations.

Ethnicity↗

PubMed2001

A rural virtual health sciences library project: research findings with implications for next generation library services.

PURPOSE: The Shared Hospital Electronic Library of Southern Indiana (SHELSI) research project was designed to determine whether access to a virtual health sciences library and training in its use would support medical decision making in rural southern Indiana and achieve the same level of impact seen by targeted information services provided by health sciences librarians in urban hospitals. METHODS: Based on the results of a needs assessment, a virtual medical library was created; various levels of training were provided. Virtual library users were asked to complete a Likert-type survey, which included questions on intent of use and impact of use. At the conclusion of the project period, structured interviews were conducted. RESULTS: Impact of the virtual health sciences library showed a strong correlation with the impact of information provided by health sciences librarians. Both interventions resulted in avoidance of adverse health events. Data collected from the structured interviews confirmed the perceived value of the virtual library. CONCLUSION: While librarians continue to hold a strong position in supporting information access for health care providers, their roles in the information age must begin to move away from providing information toward selecting and organizing knowledge resources and instruction in their use.

Computer User Training↗

PubMed2000

Health information outreach: the land-grant mission.

Service to the state is one of the core principles of the land-grant mission. This concept of service is also fundamental to a significant number of outreach activities in academic health sciences libraries, particularly those libraries affiliated with the public land-grant universities. The Dana Medical Library at the University of Vermont has a lengthy tradition of outreach to health care providers and health care consumers of the State of Vermont. Building on the foundation of the land-grant institution-which grew out of federal legislation introduced in the mid nineteenth century by Justin Morrill, Vermont's congressional representative--the Dana Medical Library has based its outreach activities on its dedication of service to the state in the promotion of healthy citizens through information dissemination in support of health care delivery. Reengineering library services designed to meet the specific information needs of its diverse clientele, partnering with disparate health care organizations, and relying on fees for service to expand its outreach activities, the Dana Medical Library has redefined the concept of health information outreach for the new millennium.

History, 19th Century↗

PubMed2000

Electronic information access in support of clinical decision making: a comparative study of the impact on rural health care outcomes.

UNLABELLED: The purpose of this project was to test whether physician access to electronic information resources in support of clinical decision making in a designated rural and medically underserved area would result in a comparable change in health care outcomes as demonstrated by access to mediated information services. METHOD: Current information habits were assessed; A tailored information intervention was provided; Use of resources against outcomes defined by previous studies was evaluated. FINDINGS: The information intervention had a significant impact on reduction of adverse events and physicians' decision patterns. CONCLUSION: Provision of information tools in support of clinical decision making at the point of care, and training in their use, can have as positive an impact on physician decision making and potential for reduction of adverse events in rural health care as access to mediated information services.

Clinical Medicine↗

PubMed1999

Medical practice and informatics tools: a vignette.

In this article the authors recreate an improvisational vignette originally presented at the Third Annual Information Connection in Burlington, Vermont, in January 1998. The vignette illustrates various state-of-the-art decision-support systems for clinical care and their promises and problems in real-world medical practice. The characters are Dr. Alex Grant, a rural physician in solo practice; Anna Everett, a patient suffering from chronic headaches; Bob, a hospital librarian; and Sarah, Dr. Grant's nurse. The short play centers on Dr. Grant's attempt to diagnose the cause of Anna's headaches (which he and she believe to be sinus-related) and the roles information technologies--Medline searching, Anna's own Internet searches, the use of MDConsult, which provides Internet access to standard medical texts, journals, etc., and a desktop decision-support tool called Problem Knowledge Couplers--play in this process. The vignette concludes with the realization that while computer technologies can be of great help in medicine "there is still a need for a good doctor to pull it all together."

Diagnosis, Computer-Assisted↗

PubMed1999

Problem Knowledge Couplers: reengineering evidence-based medicine through interdisciplinary development, decision support, and research.

The rapid growth of medical knowledge is creating a demand for new ways of providing information in support of evidence-based medical practice. Problem Knowledge Couplers are a clinical decision support software tool that offer a new approach to this growing problem. Couplers are developed through a collaboration among clinicians, informaticians, and librarians. They recognize that functionality must be predicated upon combining unique patient information, gleaned through relevant structured question sets, with the appropriate knowledge found in the world's peer-reviewed medical literature. Two pilot studies indicate that couplers can meet the gold standards of decision making within both a primary care and a specialty practice. Issues remain about how to best integrate Problem Knowledge Couplers into clinical practice and whether large-scale outcomes research will support the findings of pilot studies. However, Problem Knowledge Couplers represent a promising approach that might portend a new model for health care delivery in the next millennium.

Adolescent↗

PubMed1999

MedSpanish: a language tool for the emergency department.

Language barriers frequently impede the ability of the health care professional to provide the highest quality health care to his or her patients. Spanish speaking people are rapidly becoming the largest minority population in the United States. In order to facilitate access to appropriate medical care that would not be inhibited by miscommunication or lack of a trained translator, the MedSpanish Web Site was developed for use in the Emergency Department. The site contains common Spanish vocabularies, including translations and audio clips, that would be used in such a setting. The various sections are formatted so that they could easily become pocket cards rather than relying on the availability of a computer in a medical emergency. While MedSpanish is not designed to replace a trained translator, it does offer an effective alternative if such translations services are not available.

Communication Barriers↗

PubMed1999

The Senior Assessment Coupler: point-of-care decision support and data acquisition tool.

In an effort to provide more effective, point-of-care management of the elderly population in the state of Vermont and to begin to collect data on health care outcomes across this population, the Vermont Department of Aging and Disabilities partnered with the PKC Corporation to pilot test the Senior Assessment Coupler. Results of this pilot have shown that the Coupler is an effective tool for collecting health status information, providing decision support at the point of care, facilitating reporting to various state and federal agencies, and empowering elderly Vermonters to make informed decisions about their health care and quality of life.

Activities of Daily Living↗

PubMed1997

Efficacy of tele-endoscopy in a rural capitated market.

PURPOSE: To attempt to quantify the potential for success of tele-endoscopy as a component of the VTMEDNET Plus telemedicine implementation, a multi-part prospective study was undertaken by faculty of the Vermont Initiative for Rural Health Informatics and Telemedicine. METHOD: The study was comprised of three separate parts, evaluation of image quality, cost analysis, and identification of referring providers needs and attitudes regarding tele-endoscopy. FINDINGS: The image quality was satisfactory to support remote diagnosis in most cases; there was significant cost savings in a managed care environment; referring providers were generally positive about the attributes of tele-endoscopy. CONCLUSION: Tele-endoscopy is a viable and cost-effective component within a telemedicine system.

Capitation Fee↗

PubMed1997

Desktop teleradiology in support of rural orthopedic trauma care.

UNLABELLED: Research has shown that diagnostic quality images for most teleradiology applications requires a sophisticated telemedicine system and access to a large amount of bandwidth. While the ideal standards have been set by those involved in evaluating teleradiology, these standards are impractical for many small rural health centers which deliver routine trauma care. While there is no disagreement about the ultimate need for this level of teleradiology support, the purpose of this research was to determine whether Orthopedists would be able to read plain radiographs of orthopedic trauma injuries using a desktop teleradiology system in support of rural trauma care. METHOD: Two radiology residents and two orthopedic residents viewed forty radiographs, twenty through a desktop teleradiology system and twenty in person. Diagnostic findings and certainty of diagnosis were recorded. FINDINGS: There was no statistically significant difference between modalities in orthopedic residents' ability to correctly diagnose orthopedic trauma injuries. Further, for those instances when the diagnosis was imprecise, the residents were aware of their inability to make an accurate diagnosis. CONCLUSION: Although the study was relatively limited and further research needs to be done, the use of desktop teleradiology in support of rural orthopedic trauma consultation is a promising alternative to the more expensive forms of telemedicine technology.

Evaluation Studies as Topic↗

PubMed1996

Provider attitudes toward a rural telepathology program.

OBJECTIVE: To assess the attitudes of referring and consulting pathologists toward a recently initiated live video telepathology network in rural Vermont. METHODS: A semistructured interview was conducted with each referring pathologist before implementation of the telepathology program and again 9 months later. The interview consisted of questions concerning reasons for seeking a consultation in general and attitudes toward telepathology specifically. A questionnaire with Likert-type response categories was administered at the 9-month timepoint to the referring (N = 4) and consulting (N = 10) pathologists. This questionnaire contained items regarding communication, cost, education, quality, and timeliness aspects of telepathology. In addition, a brief mail survey was sent to attending physicians who utilized pathology services at the rural hospitals. RESULTS: The referring pathologists found the timeliness of consults using telemedicine to be a significant advantage. They also cited educational benefits both from attending telepathology conferences and from the interactive nature of the consultations. Two areas of concern were difficulties in minimizing scheduling inconveniences and uncertainty about the financial sustainability of the network. Overall, the telepathology system was well received by the consulting pathologists. Recurrent technical difficulties with the system were mentioned as a problem area. CONCLUSION: The pathologists participating in the Vermont telepathology network have reported benefiting from using this technology. Whether these benefits will outweight the costs of using telepathology for routine consultations remains to be determined.

Attitude↗

PubMed1995

The role of health sciences librarians in the teaching and retention of the knowledge, skills, and attitudes of lifelong learning.

For the past decade, the medical education community has recognized lifelong learning as a desirable educational outcome. Problem-based learning (PBL) appears to foster the requisite knowledge acquisition, skills, and attitudes. This paper briefly summarizes research that found no differences in perceptions of lifelong learning between graduates of PBL curricula and traditional curricula. The paper analyzes the assumptions that suggest such differences should exist and asserts that these assumptions are invalid within the global context of the education process. The paper concludes by suggesting a new way of looking at the teaching and retention of knowledge, skills, and attitudes of lifelong learning and the essential role that health sciences librarians must play in the process.

Clinical Competence↗

PubMed1994