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Biomedical subjects

S M Speedie

Publications and source records attributed to S M Speedie.

14 recordsLinked to original sources
PubMed2001

Change of patients' perceptions of TeleHomeCare.

The study's objectives were to measure patients' perceptions of a telehomecare system before and after they have participated in it and identify the features of the system that patients perceived differently after experiencing it. The study setting was the TeleHomeCare Project, which uses videoconferencing and Internet equipment to enable interactions between patients and nurses. An instrument that measures perceptions of telehomecare was used. Patients viewed a videotape that demonstrates a "virtual home care visit" and filled out the questionnaire (pre-test). They were then randomly assigned to a control group receiving standard care or to an experimental group receiving videoconferencing and Internet access in addition to standard care. Both groups filled out the questionnaire when exiting the system (post-test). Paired t-tests were performed to compare total scores and responses to each of the items within the groups and an unpaired t-test was used to compare change of perceptions between groups. The control group consisted of 11 patients, and the experimental group included 17 patients. There was no statistically significant change of perception in the control group. The experimental group showed an overall more positive perception of the system after their experience (total score increase by 6.059, p < 0.0001), and the mean score difference was higher compared to the control group (mean 6.241, p < 0.0001). Elderly patients evaluated their telehomecare experience as being positive, and they felt more comfortable with the technology, believing that the nurse can understand their medical problem over the television. This suggests that telehomecare has the potential for wide acceptance among patients.

Aged↗
PubMed1999

The relative cost of outpatient telemedicine services.

OBJECTIVE: This study compares the costs of offering outpatient care to primarily orthopedic and dermatology patients via live, interactive telemedicine to the estimated costs of direct face-to-face care for the same patients. MATERIALS AND METHODS: A simple, yet detailed methodology was used to evaluate the cost of adding telemedicine to a health care delivery system, using a "hub-and-spoke" model located in Minnesota. The costs and cost savings of telemedicine were evaluated from the perspectives of patients, providers, insurers, employers, and society as a whole. Sensitivity analysis was used to investigate the impact of various factors on the model. RESULTS: The variable cost of a telemedicine referral was $144, versus an estimated face-to-face referral cost of $183. Reductions in patient travel costs and in lost employee productivity were the principal benefits of the system. The break-even point, where total costs equal total cost savings, equalled 1,449 consultations annually. Sensitivity analyses indicated that the breakeven point varies from a low of 152 telemedicine consultations for a "best case" scenario to no possible breakeven point for a "worst case" scenario. CONCLUSIONS: At the system's current level of 300 consultations per year, the telemedicine system is estimated to add $45,000 to society's costs of providing medical care for these patients. The additional cost is primarily due to personnel expenses and an increase in the volume of specialty care. Patients see specialists more often due to improved access to care and lower transportation costs. Providers bear the cost while patients and employers enjoy substantial savings.

Ambulatory Care↗
PubMed1998

Prevalence variations in psychotropic treatment of children.

This study was undertaken to clarify several aspects of the estimation of prevalence of three commonly use pediatric psychotropic agents, namely, methylphenidate, desipramine, and imipramine. The study aims are threefold: (1) to show the variability of drug prevalence by comparing estimates from three data sources; (2) to show the misleading impression that can be created by reporting drug prevalence estimates based on counts of prescriptions rather than persons; (3) to show the utility of gender-by-age-specific prevalence of drug use as a marker for diagnosis. Two data sources that yield population-based prescription estimates were available: 1991 Medicaid administrative claims data for prescriptions from a mid-Atlantic state and 1991 prescription records of the northwest region of Kaiser Permanente, a staff-model health maintenance organization (HMO). Another source of data consists of the 1991 National Ambulatory Medical Care Survey, which records medication information reported during physician office visits. Data analysis consists of quantitative estimates of (1) drug prevalence from each source; (2) the ratio of prescription claims to persons; and (3) the proportion of drug use according to age and gender. Methylphenidate and desipramine prevalence had a twofold greater use among state Medicaid enrollees compared with HMO enrollees. Average claims-to-person ratios of 5:1 suggest better accuracy using persons with medication rather than prescription counts. Gender-by-age-specific prevalence rates showed that 75% of the drug use for desipramine among those less than 15 years old was found among males, whereas 75% of the desipramine use among those 15 or older was found among females, suggesting its use for the treatment of attention deficit-hyperactivity disorder among young males and for depression among older females. The variability of community physician decision making in pediatric psychopharmacology is better understood by observing drug prevalence rates from different settings. National sampling efforts should be undertaken to verify regional and setting-specific prevalence findings and to learn the reasons for their fluctuation.

Adult↗
PubMed1998

Representing metabolic pathway information: an object-oriented approach.

MOTIVATION: The University of Minnesota Biocatalysis/Biodegradation Database (UM-BBD) is a website providing information and dynamic links for microbial metabolic pathways, enzyme reactions, and their substrates and products. The Compound, Organism, Reaction and Enzyme (CORE) object-oriented database management system was developed to contain and serve this information. RESULTS: CORE was developed using Java, an object-oriented programming language, and PSE persistent object classes from Object Design, Inc. CORE dynamically generates descriptive web pages for reactions, compounds and enzymes, and reconstructs ad hoc pathway maps starting from any UM-BBD reaction. AVAILABILITY: CORE code is available from the authors upon request. CORE is accessible through the UM-BBD at: http://www. labmed.umn.edu/umbbd/index.html.

Databases, Factual↗
PubMed1992

Computers in healthcare: overview and bibliography.

OBJECTIVE: The objective of this article is to provide an overview of computer technology and an associated bibliography, emphasizing institutional-based healthcare applications and pharmacoinformatics. DATA SOURCES: References were selected from the authors' files and from a computerized search over the last five years on computers in healthcare/medical informatics and in pharmacy. STUDY SELECTION: Articles selected for review and discussion were considered to be important contributions to the respective areas listed in the bibliography and representative of advancements in computer applications in healthcare and pharmacy. DATA SYNTHESIS: The computer has become an important support tool for healthcare professionals. Medical informatics and the discipline related to pharmacy, called pharmacoinformatics, have evolved from the cognitive underpinnings of medicine, pharmacy, and computer science. Recent developments in computer technology have resulted in computers that are fast, increasingly portable, and user friendly. Hospital information systems employ computers in various ways to deal with the vast amount of information used by various departments. Standards for electronic data exchange are being developed to increase the integration potential of these systems. Hospital pharmacists have used computers for drug distribution, financial analysis and inventory control, drug interaction detection, pharmacokinetic dosing, drug information, and drug therapy monitoring. Expert systems are being developed in several areas of drug therapy. Pharmacy educators have developed interactive courseware to help students learn problem-solving skills in the areas of calculations, therapeutics, and drug information. CONCLUSIONS: Pharmacists need to become more involved with applications of technology to pharmacy. Properly implemented, computers can provide more time for pharmacists to use their cognitive skills in the delivery of pharmaceutical care.

Clinical Pharmacy Information Systems↗
PubMed1992

Evaluating drug prescribing in a large, ambulatory population: application of an embedded expert system.

DUR is a process of problem detection and intervention designed to improve the quality and economy of drug prescribing. Retrospective DUR attempts to detect and address patterns of prescribing that might be indicative of inappropriate therapy. When the process is extended to a largely ambulatory population such as Medicaid beneficiaries, a number of complications are introduced due to the large numbers of patients and sparsity of data. In order to examine the impact of implementing a Medicaid DUR program, we developed a system that would apply screening criteria to prescription claims. It has been used to screen prescribing of groups of two antihypertensive drugs in the 1990 Maryland Medicaid population for 177,409 Medicaid eligible individuals. Potentially significant problems were detected with respect to dosing, duplication of therapeutic agents and drug interactions. The system represents, we believe, a significant improvement in the ability to detect and report prescribing decisions by increasing the specificity of the detection system. By the application of this system to a set of real-world data, we have demonstrated that it is feasible to implement such a system and derive results that are potentially useful in reducing the incidence of inappropriate physician decision-making.

Ambulatory Care Information Systems↗
PubMed1992

Battered bottom lines: the impact of eroding pharmaceutical discounts on health-care institutions.

For several years, the American Society of Hospital Pharmacists (ASHP) has voiced concern about the impact of federally mandated changes on the pharmaceutical products marketplace. Since this marketplace is relatively inelastic, manipulating one segment in the interest of cost efficiencies is likely to result in price increases in other segments. That manipulation could come through such decisions as a "one-price" policy for pharmaceuticals, mandatory rebates for certain segments of the marketplace, or the elimination of discounts. The issue of cost-effective purchasing of prescription drugs and related supplies has recently come under increased scrutiny from the U.S. Congress, the Department of Health and Human Services, the General Accounting Office, and the Federal Trade Commission. In light of these and future activities, ASHP determined that there was a need to collect credible data on the potential impact of the termination of the Robinson-Patman Act's nonprofit institutional exemption, other discounts, or both on pharmaceutical expenditures in institutional health-care settings. The authors of this paper report the results and analysis of a 1990 mail survey conducted by ASHP and Concepts in Healthcare, Inc., to collect information on pharmaceutical purchasing and discounting procedures in community hospitals and selected nonhospital settings in the United States. Survey respondents reported that they would expect substantial increases in pharmaceutical expenditures if volume and nonprofit discounts were eliminated. Nonprofit hospitals expected a 24.4% increase in pharmaceutical expenditures in the wake of discount elimination, while for-profit institutions projected an 11.9% increase. Pharmaceutical expenditures of the study hospitals averaged $1.69 million per year; respondents estimated that this sum would increase by $390,000 (23.1%) if volume and nonprofit discounts were eliminated.

Cost Control↗
PubMed1991

Incidence and characteristics of antibiotic use in aged nursing home patients.

OBJECTIVE: To measure the prevalence, incidence, types, and certain characteristics of antibiotics prescribed in nursing homes. DESIGN AND SETTING: Periodic survey over 1 year of patient charts in 53 stratified, randomly selected nursing homes in the state of Maryland. PATIENTS: All patients 65 years of age or more residing in these nursing homes on the first day of study. RESULTS: Of 4,165 patients in 53 nursing homes, records over the year were satisfactory in 3,899 patients in 52 nursing homes. The prevalence of antibiotic use on the first day of the study was 8%. Over the next 12 months, observations of more than one million patient-days revealed an incidence of 0.46 antibiotic courses/100 patient-days; 54% of the 3,899 patients received at least one antibiotic course. For presumed active infections, beta lactam antibiotics were the most commonly used, 54% of antibiotic orders. For all antibiotics, urinary tract infection was the most common indication, eliciting 36% of orders including 9% for asymptomatic bacteriuria. Skin, lower respiratory, and upper respiratory infections comprised 14%-17% each. Physicians prescribed 94% of courses but documented examinations of only 44% of patients at the outset of these courses. Consensus criteria for minimal diagnostic evaluation of four selected infections were met in only 11% of episodes of infection. Although the most serious infections tended to be better evaluated than others, 31% of the former were not noted to have been examined by a physician. Three percent of orders were for prophylaxis and two-thirds of these antibiotics were administered for more than 2 days. CONCLUSIONS: Antibiotics are frequently prescribed for aged nursing home patients, often in the absence of a physician's examination and other features commonly performed in evaluation of specific infectious diseases. More than one-fifth of antibiotics prescribed by presumed active infections were for two infections usually thought not to require antibiotic therapy, "viral" upper respiratory infection (13%) and asymptomatic bacteriuria (9%). To optimize antibiotic use in nursing homes, greater attention should be directed to appropriate durations of prophylaxis for urologic, dental, and minor surgical procedures; to standards for diagnostic evaluations of common infections; and to the roles of antibiotics in upper respiratory infections and in asymptomatic bacteriuria.

Aged↗
PubMed1990

Detecting drug interactions: a review of the literature.

This article provides a historic overview of drug interaction screening and reviews 19 studies that have sought to measure the frequency of drug interactions. Differences in study designs, methodologies, and definitions contribute to considerable variation in the reported incidence rates, which ranged from 2.2 to 70.3 percent for all potential drug interactions. The percentage of patients actually experiencing symptoms that could be attributed to a drug interaction, however, ranged from 0 to 11.1 percent. The relative importance of drug interactions as a clinical problem remains unclear. Screening programs that do more than simply identify large numbers of patients who receive potentially interacting drug combinations without indicating which subpopulations of these individuals are likely to be harmed by the drugs have not yet been developed.

Ambulatory Care↗
PubMed1988

Antihypertensive therapy for the elderly: an expert system to assist therapeutic decisions.

The prevalence of hypertension among the elderly is high. Recent multicenter studies have shown hypertension, especially isolated systolic hypertension, to be a risk factor and treatment to be effective, if individualized. In addition, the presence of multiple complicating conditions and the need for multiple medications in the elderly increases the required medical knowledge base necessary to appropriately determine antihypertensive therapy. To assist the primary provider, an expert system has been developed that provides advice on therapeutic decisions for elderly patients (greater than 65 years old and less than 85 years old). It takes into account such factors as age, sex, lifestyle, site of care, nutritional status, physiologic and pathophysiologic changes, co-existing diseases, multiple drug use, and prior antihypertensive drug exposure and response. The system user enters patient characteristics, disease states, risk factors, relevant laboratory values, and prior drug therapy. The system responds with a set of recommendations of appropriate therapy individualized for the specific patient. To further assist the process, relative costs of therapy are also included. The system, consisting of over 200 rules, is currently undergoing validation by a panel of cardiologists. It is implemented in IBM's Expert System Environment (ESE) on the IBM 4341. The authors wish to acknowledge the contribution of the ESE software by the IBM Corporation.

Aged↗
PubMed1981

The effect of inservice education provided by consultant pharmacists on the behavior of nurses in long-term care facilities.

The objectives of the study were to assess whether an inservice education program for nurses in long-term care facilities was effective in increasing the nurses' knowledge of drugs and whether the increased knowledge affected nurses' behavior regarding drug therapy monitoring. The four-phase study was conducted in two study homes and two control homes and consisted of pre-tests, inservice, post-tests, and a three-month evaluation period. There results indicate that nurses in the study homes demonstrated a statistically significant increase in drug knowledge, and this was reflected in an objective change in behavior to more appropriate monitoring of drug therapy. It may be concluded that intensive inservice education programs are an effective method for inducing behavioral changes in nurses working in long-term care settings. These changes can improve the nurses' ability to monitor and promote safe and efficacious drug therapy in long-term care facilities.

Consultants↗
PubMedDate not supplied

Considerations for the design of a Web-based clinical monitoring and educational system for elderly patients.

Designing a Web system for elderly patients requires attention to the users' functional impairments and inexperience with computers. The authors reviewed published guides for the design of Web-based clinical systems for elderly patients and identified additional design considerations that have not been reported in the literature. The resulting recommendations are related to the system interface, the training and support of users, and the content of Web pages. The recommendations can be used as design objectives for Web-based systems for elderly patients, which emphasize system usability and aim to optimize patients' error-free use of these systems.

Aged↗