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At least 217 records · Page 12Linked to original sources

PubMed2000

Formal combinations of guidelines: a requirement for self-administered personalized health education.

This paper addresses a process in which we combined educational guidelines (EG) from heterogeneous sources in one set of coherent computable statements to support dynamically generated and precisely tailored patient education material. The Guideline Interchange Format (GLIF), predicate logic and decision tables were assessed. An extended formalism of GLIF was applied to break up composite sentences of the educational material in atomic sentences. The differentiation of atomic sentences and combinations of atomic sentences from heterogeneous sources lead to a simplified overall content and model, and a significant reduction of conditional sentences in the EG. The resulting streamlined and personalized guidelines are expected to provide an improved user experience.

Chest Pain↗

PubMedDate not supplied

A guide to risk assessment.

Mental health service users experience increased risk in relation to a number of specific problems, including an increased risk of suicide, self-injury, neglect, exploitation (physical, financial or sexual) and violence towards others. Risk assessment is linked to the practice of risk management, whereby a mutually agreed plan, aimed at reducing identified risks, is negotiated with the individual concerned. The plan incorporates specific therapeutic strategies and is a collaborative, interactive and dynamic process rather than something that is 'done to' the person. Although risk assessment is a core nursing skill, it needs to occur within the multi-professional context and involves other relevant disciplines.

Humans↗

PubMedDate not supplied

Impact of dedicated skate parks on the severity and incidence of skateboard- and rollerblade-related pediatric fractures.

Dedicated skate parks have led to an increase in pediatric fractures referred to the authors' unit. The authors performed a prospective analysis of all patients presenting to their unit with fractures sustained while Rollerblading or skateboarding over a 5-month period. Epidemiologic data, user experience, wearing of protective gear, place of injury, and mechanism of injury were collected. Fracture type and its treatment were also recorded. The findings indicated that the use of skate parks is associated with a significant increase in the severity of fracture. This was not related to mean length of experience, age, or sex. The use of skate parks had an increased relative risk of 8.35 for fractures requiring manipulation or invasive orthopedic treatment. Only 5% of children were wearing some form of limb/joint protective gear. The authors believe there should be closer supervision and training of children and more emphasis on limb protective gear. The current high incidence of significant skate park injuries will otherwise continue, with implications for the well-being of these children and the burden on the healthcare system.

Adolescent↗

PubMed2004

[The role of anti-ulcerative drugs in treatment and prevention of gastropathies induced by nonsteroidal anti-inflammatory drugs].

Nonsteroidal anti-inflammatory drugs (NSAIDs) as effective agents for the relief of pain and inflammation are among the most widely prescribed drugs. Unfortunately, their benefits especially for patients with osteoarthritis and other chronic musculoskeletal conditions, are accompanied by well established toxicity. A significant percentage of NSAIDs users experience some type of gastrointestinal adverse events, ranging from manageable dyspepsia to clinically important complications (gastrointestinal bleeding, ulcer perforation, obstruction). In an attempt to reduce the incidence of NSAID-induced gastropathy, the following approaches have been proposed: avoidance of NSAIDs or minimising their dosage, selecting NSAID known to cause less damage and coprescription of various agents. Patients who require NSAIDs therapy should be assessed for factors that increase risk of gastrointestinal damage. In high risk patients, use of misoprostol, which reduces even serious gastrointestinal complications, or proton pump inhibitors, whose efficacy in preventing gastroduodenal ulcers due to NSAIDs exposure has been demonstrated in large clinical trials, is possible to use. The first step in the treatment of NSAID-associated ulcers lies in discontinuation of NSAIDs therapy. If NSAIDs cannot be withdrawn, an antisecretory therapy should be initiated. Proton pump inhibitors appear to be the most effective at healing NSAID-related ulcers among whose with continuous NSAIDs therapy. Another therapeutic option in the management of NSAID-gastropathy is to use specific cyclooxygenase-2 inhibitors. However, the clinical experience with these agents is still limited and further surveillance to resolve this issue as well as e.g. the role of Helicobacter pylori infection in NSAID-induced gastrointestinal injury are needed.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2005

Improving pathway compliance and clinician performance by using information technology.

To deliver patient-specific advice at the time and place of a consultation, to improve clinician performance and compliance by using computer-based decision support, and to integrate such IT solutions with the clinical workflow are important strategies for the implementation of clinical pathways. User acceptance plays a critical role: additional effort has to be balanced with enough benefit for the users. Experiences from routine use of an online surgical pathway at Marburg University Medical Center show that it is possible to successfully address this issue by seamlessly integrating patient-specific pat documentation tasks which have to be done anyway and by substantially reusing entered data to accelerate routine tasks (e.g. by automatically generating orders and reports).

Academic Medical Centers↗

PubMed2005

Introducing digital radiography in the dental office: an overview.

Digital radiography is gaining in popularity and many dentists are considering changing from a film-based system to this new technology. Dentists must clearly define their objectives for adopting digital radiography and be aware of the problems that may be encountered with this equipment, so that they can make an informed purchasing decision. This article provides an overview of digital radiographic equipment, experiences users have had with this technology and factors to consider when deciding to purchase a DR system.

Adult↗

PubMed2006

CSI-ISC--Concepts for smooth integration of health care information system components into established processes of patient care.

OBJECTIVES: The introduction of information system components (ISCs) usually leads to a change in existing processes, e.g. processes of patient care. These processes might become even more complex and variable than before. An early participation of end users and a better understanding of human factors during design and introduction of ISCs are key factors for a successful introduction of ISCs in health care. Nonetheless no specialized methods have been developed until now to systematically support the integration of ISCs in existing processes of patient care while taking into account these requirements. In this paper, therefore, we introduce a procedure model to implement Concepts for Smooth Integration of ISCs (CSI-ISC). METHODS: Established theories from economics and social sciences have been applied in our model, among them the stress-strain-concept, the contrastive task analysis (KABA), and the phase model for the management of information systems. RESULTS: CSI-ISC is based on the fact that while introducing new information system components, users experience additional workload. One essential aim during the introduction process therefore should be to systematically identify, prioritize and ameliorate workloads that are being imposed on human beings by information technology in health care. To support this, CSI-ISC consists of a static part (workload framework) and a dynamic part (guideline for the introduction of information system components into existing processes of patient care). CONCLUSIONS: The application of CSI-ISC offers the potential to minimize additional workload caused by information system components systematically. CSI-ISC rationalizes decisions and supports the integration of the information system component into existing processes of patient care.

Germany↗

PubMedDate not supplied

[Independent living and household management by handicapped elderly patients using new technologies].

Is it possible to enable handicapped elderly to manage their household autonomously by the use of new technologies? The article deals with this question, which is of great importance for the elderly and the society as well. Disabilities are pointed out that can hinder autonomous living and housekeeping. Then categories of equipment are shown which may substitute for deficiencies in daily life activities, household management, housekeeping, educational and other activities. This scheme serves as a basis for analysis of the market for new technologies, their attributes, prices, and follow-up costs. It is shown that new technologies are not able to substitute social services in the area of basic activities and care of the elderly. But some kinds of equipment and information- and communication technology may, under certain conditions, improve mobility, social integration, and housework. Further information as well as measures are needed in regard to user experiences and financing new technologies in the framework of rehabilitation of the elderly.

Activities of Daily Living↗

PubMed1990

[The personal computer for administrative routines at a radiology department].

The article describes a radiological information system (RIS) developed by members of the medical staff at a university hospital. Software has been developed on the basis of the two common databases; dBASE III plus and Clipper. The system is modular constructed. Each module can be operated individually, but best function is obtained by networking in a Ethernet (3Com). The article describes the different modules, user experience and future plans for development.

Diagnosis, Computer-Assisted↗

PubMed1990

Serologic investigations in a New York City cohort of parenteral drug users.

Human immunodeficiency virus (HIV) infection continues to be a major health problem for society. Intravenous drug users are the second largest risk group for HIV infection. The disease primarily affects immunologic functioning. This study examined the inherent immunologic dysfunction by measuring the seroprevalence of infection against pathogens often associated with HIV infection. Additionally, chi square analysis was used to compare intravenous drug users with a non-drug-using control group to see if any difference existed in the prevalence of antinuclear antibody, rheumatoid factor, abnormal titer of antibody to Toxoplasma gondii, cytomegalovirus, and herpes simplex virus (types 1 and 2). The intravenous drug users had a significantly greater level of antibody titers for antinuclear antibody and Toxoplasma gondii than did controls. Abnormal serologic results were not significantly associated with HIV seropositivity. The findings of this study suggest that intravenous drug users experience a greater prevalence of alteration in serologic markers unrelated to HIV exposure.

Adult↗

PubMedDate not supplied

Contraceptive failure in the United States: estimates from the 1982 National Survey of Family Growth.

A multivariate life-table analysis of national survey data from 1982 indicates that among currently married women, the pill and IUD have the lowest use-failure rates. During the first year of use, about three percent of pill users and six percent of IUD users experience an unintended pregnancy. Failure rates for the remaining methods range from 14 percent for the condom to 22 percent for spermicides; between these lie rhythm and natural family planning (16 percent), the diaphragm (17 percent) and other methods, mainly withdrawal, douche and abstinence. Married women using no contraceptive method experience an unintended pregnancy rate of 40 percent during the first year of unprotected intercourse. A woman's age, pregnancy intention (either to delay or to prevent births), parity and income all have significant effects on the risk of unintended pregnancy. The risk generally declines with age, except for women attempting to prevent an unwanted pregnancy, among whom women under 20 have lower failure rates than do those 20-29 years of age. As expected, women attempting to prevent an unwanted pregnancy have lower failure rates than do those seeking to delay a wanted pregnancy, with the difference being greatest for women under 20 years of age and smallest for 20-29-year-olds. Use-failure rates among low-income women are higher than those among women with larger family incomes, while low-parity women have lower failure rates than do women of higher parity. On average, standardized use-failure rates for single women are lower than those for married women, probably because of a lower average level of intercourse among single women. In addition, these rates are understated because of the substantial underreporting of abortion among single women; if abortion reporting were complete, failure rates would be about 1.4 times as high as they appear here, and thus would be close to those of married women. Differences in the risk of unintended pregnancy among single women show a number of similarities with those seen among married women: Use of the pill and IUD is associated with the lowest failure rates, reliance on the condom is associated with intermediate failure rates, and use of spermicides is linked with the highest failure rates. However, while rhythm and the diaphragm exhibit use-failure rates that are among the highest found for single women, failure rates for these methods are at intermediate levels among married women.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1983

Evaluation of "in feed" vaccination of piglets and sows against enteropathogenic "E. coli" using environmental production parameters.

Current approaches to the immunological control of enteric E. coli infections in pig herds concentrate on the provision of passive immunity for the neonate by multiple parenteral vaccination of the sow to stimulate colostral antibody production. Little account is taken of the kinetics of the animals' natural immune response. In particular the potential of the gut as a target organ for immunization has largely been ignored in practical disease control. A new approach to the problem, which combines oral with parenteral vaccination, stimulates a colostral antibody response closely mimicking a sow's natural response to infections and comparison between this and classical parenteral vaccination, using an acute E. coli infection model, demonstrated the greater protective efficacy conferred by the new protocol. The widespread use of this method of vaccination has been continuously monitored, using production parameters most relevant to the farming industry. From this evaluation of user experience and results of trials conducted in various locations, a new perspective is emerging which indicates the vaccine has a wider spectrum of biological activity than was expected. Production, health and environmental benefits are arising which could not have been predicted from a model merely concerned with the control of alimentary E. coli infection.

Age Factors↗

PubMed1978

Computerization of clinical laboratory procedure manuals.

Current code requires federally licensed clinical laboratories to have standard operating procedure manuals describing all tests performed. A computerized system for generating, revising, and excerpting manuals, which produces hard copy and microfiche, has been developed and appears to meet the regulatory criteria. The salient aspects of pertinent federal regulations, the features of the computerized system, the format of the manual, the users' experience therewith are described.

Computers↗

PubMed1995

Clinical evaluation of Norplant in Kumasi, Ghana.

A non-comparative study of the Norplant contraceptive subdermal implant system was conducted in Kumasi, Ghana. A total of 100 acceptors were enrolled in the clinical trial, which began in 1987. There were no pregnancies during the first two years of use. Only nine post-insertion medical problems were reported during the first two years of use. One woman in this study requested removal for menstrual pattern changes through two years of use. As assessed through user-satisfaction questionnaires administered at approximately six months of use, there has been an overall positive user experience with Norplant in this study. Although the sample size in this study is small, our results seem to be consistent with other studies and it appears that Norplant offers an effective, safe and acceptable method of contraception for Ghanaian women.

Adult↗

PubMed1994

Long-acting injectable contraception with depot medroxyprogesterone acetate.

Depot medroxyprogesterone acetate (DMPA) is the only injectable contraceptive available in the United States. After more than 20 years of regulatory review, the Food and Drug Administration approved DMPA for contraceptive use in 1992 after the publication of reassuring data about its possible association with breast cancer. It has been used by 30 million women in more than 90 countries. The recommended dosage, 150 mg intramuscularly every 3 months, has a contraceptive efficacy exceeding 99%. After a 150 mg dose, ovulation is inhibited for at least 14 weeks. Almost all users experience menstrual changes, typically episodes of unpredictable irregular spotting and bleeding, particularly during the first year of use. With continued use, spotting and bleeding decrease, and amenorrhea becomes common. Although ovulation suppression may rarely persist for as long as 18 months after the last injection, DMPA does not permanently affect fertility. Long-term DMPA use reduces menstrual blood loss, has been associated with a decreased incidence of candidal vulvovaginitis and pelvic inflammatory disease, and dramatically lowers the risk of endometrial cancer. Prolonged DMPA use may be associated with reversible reduction in bone density, probably related to suppression of endogenous production of estrogen. The most recently published data suggest that long-term use of DMPA induces moderate changes in lipid metabolism that are unfavorable in terms of risk of atherosclerosis. DMPA should be considered a highly effective, safe, convenient, and reversible contraceptive option for appropriately selected patients.

Delayed-Action Preparations↗

PubMed1997

Perspectives on AAC systems by the users and by their communication partners.

The study examined the perspectives of augmentative and alternative communication (AAC) users and their 'formal' and 'informal' communication partners in relation to two areas of relevance to AAC: firstly, communication strategies, and secondly, advantages and disadvantages of AAC systems. With respect to communication strategies, it was found that formal communication partners thought that more vocabulary for communicating social purposes was actually available to AAC users and they were less aware of daily routines within day and residential environments. With respect to advantages and disadvantages, three main areas of concern emerged: the effect of the AAC system on the users' communication; features of AAC systems; and the effect of AAC on the users' quality of life. Both high- and low-technology AAC systems were seen as having advantages and disadvantages. This study demonstrates the important contribution to be made by AAC users in the provision of a new set of priorities based on their user experiences.

Adolescent↗

PubMedDate not supplied

Home is where their wheels are: experiences of women wheelchair users.

This paper examines the experiences of mothers who are wheelchair users in their roles of homemaking and parenting. A qualitative study using in-depth, focused interviews was conducted with a purposeful sample of 11 women with various physical disabilities. Three major themes were uncovered in the data: (a) lived space restricting personal autonomy, (b) advocacy strategies to secure appropriate housing, and (c) my wheelchair, my liberator, my sense of comfort. Findings from this study showed that women did not have the freedom or economic resources to seek out new living arrangements or make modifications to existing environments. Lack of space, stairs, difficult-to-reach spaces, poor transportation, and limited community access were barriers that women experienced. The study also points to the importance of recognizing that the women used many strategies to regain control over aspects of their environment to enable greater autonomy and participation for themselves. Sensitivity to the meaning of home and the relationship between the body and the environmental features that surround it may be a significant contribution of the clinician as he or she seeks to assist women wheelchair users.

Activities of Daily Living↗

PubMed2004

Deaths associated with implantable cardioverter defibrillator failure and deactivation reported in the United States Food and Drug Administration Manufacturer and User Facility Device Experience Database.

OBJECTIVES: The aim of this study was to understand the causes of implantable cardioverter defibrillator (ICD) failure and complications so that adverse events, including unnecessary death, can be prevented. BACKGROUND: Sudden death may occur if an ICD fails to treat life-threatening ventricular arrhythmias. METHODS: The United States Food and Drug Administration Manufacturer and User Facility Device Experience Database was searched for ICD devices and the search term "death." The search yielded 212 death events involving 100 ICD pulse generator and lead models from five manufacturers. These death events were associated with (A) ICD devices for which pulse generator interrogation data and/or the results of the manufacturers analysis of returned devices were available; (B) ICD devices for which neither interrogation data nor the results of the manufacturer's analysis were reported; and (C) normally functioning ICDs that had been deactivated. RESULTS: (A) A total of 103 (69%) of 150 death events were associated with defective pulse generators or high-voltage leads. Most (34/42 [81%]) apparently sudden or arrhythmic death events were associated with high-voltage lead failure; other deaths were related to pulse generator failure (8/42 [19%]) caused by electronic component defects. (B) A total of 21 of 51 death events were related to a manufacturer's recall; all deaths were arrhythmic but without allegation of device failure. (C) Eleven death events occurred in patients whose pulse generators were found to be off or deactivated; these devices appeared to have been deactivated accidentally or by exposure to magnetic fields, or they were not reactivated after elective surgery. CONCLUSIONS: ICD device failure and unintended pulse generator deactivation have resulted in unnecessary deaths. Although these deaths may be infrequent, improved devices and follow-up techniques are needed. The magnet deactivation feature probably is unsafe, and health professionals and patients should be cautioned.

Databases as Topic↗