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PubMed2001

Participation in arranging continuing health care packages: experiences and aspirations of service users.

AIMS: This paper examines patients' and carers' experiences of receiving community health services, and considers the degree of patients' participation in the management of their continuing care. BACKGROUND: Care management, advocated for many years as a way of ensuring appropriate and coordinated care, emphasizes the involvement of patients and carers in care planning. Evidence suggests that such involvement is unusual. METHODS: Semi-structured interviews were carried out with 99 continuing health care patients and/or their carers. FINDINGS: A few informants had willingly chosen to be active in arranging and coordinating their care, and a few others, who did not take an active role, were very satisfied with the services which they received. The majority, however, were not satisfied, feeling unclear about how their needs had been assessed and how services had been arranged. They were mostly disappointed by the absence of information and by the lack of regular contact with NHS and/or Social Services personnel. Some had felt compelled to become proactive in order to ensure that the care provided was adequate. CONCLUSIONS: Community nurses are valued by patients, and are well placed to be care managers. However, less qualified staff are also able to offer the regular support and information which patients want and value.

Adult↗
PubMed2005

A basis for electronic cognitive simulation: the heuristic patient.

Although medical trainees are expected to become expert quickly and safely, limited electronic methods are available to rehearse medical cognition for common outpatient and non-emergent inpatient problems. We conducted a series of formal observational sessions designed to determine what interaction requirements are desirable for student rehearsal of medical management by using an electronic patient. The studies utilized both manual and electronic methods for a student to evaluate and manage patients with medical and surgical problems. We observed the following major requirements for an effective simulation experience: the user must have a trial-and-error experience with the patient; the user must have unconstrained access to query and treat the patient; anatomic and physiologic values in the patient must change appropriately in response to user actions; and the user must be able to control certain time-related aspects of the simulation. When these requirements are implemented within a simulation, user-directed management of an electronic patient, by itself, becomes a strong aid to learning by trial- and-error techniques. We conclude that the heuristic patient is a practical and useful concept. Once fully developed, it would allow rehearsal of patient care decision making, intrinsically demonstrating trainee knowledge deficits, and resulting in self-directed learning.

Clinical Clerkship↗
PubMedDate not supplied

The need for end-user studies: IMA's experience.

Since 1966 two main types of studies have been carried out at IMA: (a) Studies conducted before the implementation of MEDLINE, to investigate the information needs of future users. (b) Studies of the actual use of the system. The main results of these studies are presented.

Humans↗
PubMed2003

A metabolic network analysis & NMR experiment design tool with user interface-driven model construction for depth-first search analysis.

A Windows program for metabolic engineering analysis and experimental design has been developed. A graphical user interface enables the pictorial, "on-screen" construction of a metabolic network. Once a model is composed, balance equations are automatically generated. Model construction, modification and information exchange between different users is thus considerably simplified. For a given model, the program can then be used to predict all the extreme point flux distributions that optimize an objective function while satisfying balances and constraints by using a depth-first search strategy. One can also find the minimum reaction set that satisfies different conditions. Based on the identified flux distributions or linear combinations, the user can simulate the NMR and GC/MS spectra of selected signal molecules. Alternately, spectra vectorization allows for the automated optimization of labeling experiments that are intended to distinguish between different, yet plausible flux extreme point distributions. The example provided entails predicting the flux distributions associated with deleting pyruvate kinase and designing 13C NMR experiments that can maximally discriminate between the flux distributions.

Computer Simulation↗
PubMed2006

A comparison of oral health related quality of life between complete and partial removable denture-wearing older adults in Korea.

The purpose of this study was to compare the oral health related quality of life (OHRQoL) between older Korean adults with complete and partial removable dentures using oral health impact profile (OHIP). A pool of 4250 Korean older adults was identified by random stratification by area from the sample cohort of Korean National Survey of Oral Health in the year of 2000. Out of the potential pool, 445 subjects with removable partial dentures (RPDs) or complete dentures (CDs) agreed to be interviewed by telephone. Each question in the survey was about how frequently each event was experienced during the past 12 months. To analyse the association between OHIP scores and removable denture status, bivariable analysis and multiple linear regression analysis were used. RPD users showed higher scores on eight items than CD users. They were 'breath stale', 'food catching', 'sensitive teeth', 'toothache', 'tense', 'unable to brush teeth', 'less tolerant to family members' and 'irritable with others'. RPD users might be associated with higher scores of functional limitation, physical pain and psychological discomfort than CD users. RPD users had slight tendency to be associated with higher OHIP-49 score than CD users, but it was not statistically significant. The findings of the present study confirm that there is no general OHRQoL difference between RPD and CD users. But in the items and subscales of OHIP, RPD users might experience more impaired OHRQoL than CD users.

Age Distribution↗
PubMedDate not supplied

Borderless teleradiology with CHILI.

Teleradiology is one of the most evolved areas of telemedicine, but one of the basic problems which remains unsolved concerns system compatibility. The DICOM (Digital Imaging and Communications in Medicine) standard is a prerequisite, but it is not sufficient in all aspects. Examples of other currently open issues are security and cooperative work in synchronous teleconferences. Users without a DICOM radiological workstation would benefit from the ability to join a teleradiology network without any special tools. Drawbacks of many teleradiology systems are that they are monolithic in their software design and cannot be adapted to the actual user's environment. Existing radiological systems currently cannot be extended with additional software components. Consequently, every new application usually needs a new workstation with a different look and feel, which must be connected and integrated into the existing infrastructure. This paper introduces the second generation teleradiology system CHILI. The system has been designed to match both the teleradiology requirements of the American College of Radiology (ACR), and the functionality and usability needs of the users. The experiences of software developers and teleradiology users who participated in the first years of the clinical use of CHILI's predecessor MEDICUS have been integrated into a new design. The system has been designed as a component-based architecture. The most powerful communication protocol for data exchange and teleconferencing is the CHILI protocol, which includes a strong data security concept. The system offers, in addition to its own secure protocol, several different communication Methods: DICOM, classic e-mail, Remote Copy functions (RCP), File Transfer Protocol (FTP), the internet protocols HTTP (HyperText Transfer Protocol) and HTTPS (HyperText Transfer Protocol Secure),and CD-ROMs for off-line communication. These transfer METHODS allow the user to send images to nearly anyone with a computer and a network. The drawbacks of the non-CHILI protocols are that teleconferences are not possible, and that the user must take reasonable precautions for data privacy and security. The CHILI PlugIn mechanism enables the users or third parties to extend the system capabilities by adding powerful image postprocessing functions or interfaces to other information systems. Suitable PlugIns can be either existing programs, or dedicated applications programmed with interfaces to the CHILI components. The developer may freely choose programming languages and interface toolkits. The CHILI architecture is a powerful and flexible environment for Picture Archiving and Communications Systems (PACS)and teleradiology. More than 40 systems are currently running in clinical routine in Germany. More than 300,000 images have been distributed among the communication partners in the last two years. Feedback and suggestions from the users influenced the system architecture by a great extent. The proposed and implemented system has been optimized to be as platform independent, open, and secure as possible.

Radiology Information Systems↗
PubMed2005

Auditory cortical activation and speech perception in cochlear implant users: effects of implant experience and duration of deafness.

This study aimed to investigate the relationship between outcome following cochlear implantation and auditory cortical activation. It also studied the effects of length of implant use and duration of deafness on the auditory cortical activations. Cortical activity resulting from auditory stimulation was measured using [(18)F]FDG positron emission tomography. In a group of 18 experienced adult cochlear implant users, we found a positive correlation between speech perception and activations in both the primary and association auditory cortices. This correlation was present in a subgroup of experienced implant users but absent in a group of new implant users with similar speech perception abilities. There was a significant negative correlation between duration of deafness and auditory cortical activation. This study gives insights into the relationship between implant speech perception and auditory cortical activation and the influence of duration of preceding deafness and implant experience.

Acoustic Stimulation↗
PubMed2003

A flicker paradigm for inducing change blindness reveals alcohol and cannabis information processing biases in social users.

AIM: To apply a new paradigm using transient changes to visual scenes to explore information processing biases relating to "social" levels of alcohol and cannabis use. PARTICIPANTS: Male and female student volunteers (n = 200) not self-reporting substance-related problems. SETTING: Quiet testing areas throughout the university campus. DESIGN: A flicker paradigm, for inducing change blindness with lighter and heavier social users of alcohol (experiment 1, n= 100) and social users and non-users of cannabis (experiment 2, n= 100), explored the associations between habitual level of use and the latency to detection of a single substance-related or neutral change made to a scene of grouped substance-related and neutral objects. MEASUREMENTS: Alcohol use was measured as the number of units of the heaviest drinking day from the previous week; cannabis use as the number of months of use in previous 12. Change-detection latency comparisons were used to evaluate processing biases. FINDINGS: In both experiments, (i) heavier social users detected substance-related changes quicker than lighter and non-users; (ii) lighter and non-users detected substance-neutral changes quicker than heavier users; (iii) heavier social users detected substance-related quicker than substance-neutral changes; and (iv) lighter and non-users detected substance-neutral changes quicker than substance-related changes. CONCLUSIONS: Alcohol and cannabis processing biases are found at levels of social use, have the potential to influence future consumption and for this reason merit further research.

Adult↗
PubMedDate not supplied

Oral contraceptives and reproductive cancers: weighing the risks and benefits.

The hypothetical incidence of reproductive cancers resulting from oral contraceptive use was estimated in several models comparing the cumulative lifetime incidence of cancer of the breast, cervix, ovary and endometrium expected in pill users with the incidence expected in nonusers. The potential number of cancer-free days that would be gained or lost by pill users was compared with similar estimates among nonusers. If five years or more of pill use were associated with a 20% increase in the risk of breast cancer being diagnosed before age 50, a 20% increase in cervical cancer risk and a 50% reduction in the risks of ovarian and endometrial cancers, then every 100,000 pill users would experience 44 fewer reproductive cancers during their lifetime than would nonusers, and would gain one more day free of cancer. If higher estimates of the five-year pill-associated risks of breast and cervical cancer are used--a 50% increased risk of each, for example--then pill users would experience more reproductive cancers than nonusers and would have 11 fewer cancer-free days of life.

Adult↗
PubMed2003

Risk factors for anabolic-androgenic steroid use among weightlifters: a case-control study.

Anabolic-androgenic steroid (AAS) use represents a major public health problem in the United States, but the risk factors for this form of drug use are little studied. We evaluated 48 men who had used AAS for at least 2 months and 45 men who had never used AAS, using a verbal interview and a battery of questionnaires covering hypothesized demographic, familial, and psychosocial risk factors for AAS use. All subjects in both groups were experienced weightlifters; thus, differences between groups were likely to be associated specifically with AAS use, rather than with weightlifting in general. The AAS users and non-users generally described similar childhood and family experiences, but users reported significantly poorer relationships with their fathers and greater childhood conduct disorder than non-users. At the time that they first started lifting weights, AAS users and non-users were similar in their perceived physical, social, and sexual status, but users were significantly less confident about their body appearance. AAS users displayed much higher rates of other illicit substance use, abuse, or dependence than non-users, with use of other illicit substances almost always preceding first use of AAS. These findings suggest that AAS use may be most likely to occur in men with high levels of antisocial traits and low levels of body esteem.

Adult↗
PubMed2006

A user-centred deployment process for ICT in health care teams--experiences from the OLD@HOME project.

OBJECTIVE: To present a user-centred method for introducing ICT in health care organisations, taking factors that influence acceptance into account. METHODS: User centred methods are used in combination with previous research regarding factors that affect user acceptance, in order to facilitate users' acceptance of new ICT tools. RESULTS: A method is presented that supports the introduction of ICT in team work. The method consists of three major steps; (1) the start-up seminar, (2) end user education and (3) continuous follow-up during the deployment phase. Important results of the start-up seminar are documentation of the users' expectations, and an agreement of ground rules that supports both the social norm factor and the users' perceived behavioural control. Education and follow-up also improve perceived behavioural control, and by involving super users perceived usefulness and ease of use can be improved through subjective norm. CONCLUSION: Key factors in the deployment process are; user participation, end user experience and education, and continuous follow-up of the process.

Computer Literacy↗
PubMed2005

Comparison of the sensitivity of physical and virtual laparoscopic surgical training simulators to the user's level of experience.

BACKGROUND: The recent focus on quality of care and patient safety has been accompanied by increased interest in standardizing the training for laparoscopic surgeons. Studies have shown that laparoscopic simulators can be used to train surgical skills. Therefore, we designed an experiment to compare the effectiveness of two popular training systems. One system was based on a physical model, whereas the other used a virtual reality model. METHODS: A total of 32 medical students and residents were tested on both simulators. Time required for task completion and number of errors committed were recorded and compared. RESULTS: The physical training system differentiated among experience levels on three of the five tasks when time was used as a measure and four of five tasks when score was used, whereas the virtual reality system yielded statistically significant results in eight of 13 tasks for time and in five of 13 tasks for score. CONCLUSION: The physical model is more sensitive than the virtual reality one in detecting differences in levels of laparoscopic surgical experience.

Computer Simulation↗
PubMed1993

Prison experience of injecting drug users in Glasgow.

Five hundred three injecting drug users in Glasgow recruited by a multisite and citywide sampling strategy were questioned regarding their drug-taking behaviour during episodes of custody over the six months prior to interview. Fifty-two percent had been in custody during the past 6 months, 16% of these had injected while in custody. Of these 73% borrowed injecting equipment and 78% handed on used equipment to others. All those who shared, cleaned their injecting sets before use. Over half of those who injected had a source of new sets. While the potential exists for spread of HIV among drug users while in custody there is clear understanding among them of the route by which the virus is spread and also the will to prevent it.

Cross-Sectional Studies↗
PubMed1993

The posthospital experience of elderly Medicare home health users.

This study describes the home health experience of 295 Medicare elderly persons following hospitalization. While a subset of persons improved medically and functionally during the home health service period, some declined on one or both dimensions and many showed not change. The most heavily utilized, non-Medicare, services were personal care and homemaker/chore, reflecting the functional needs of some posthospital elderly. One-fifth of Medicare home health users were reinstitutionalized or died during the service period. Those discharged to home had a range of continuing service needs, both medical and functional, after home health discharge.

Activities of Daily Living↗
PubMed1997

The everyday experience of psychiatric hospitalization: the users' viewpoint.

Using 38 focussed accounts the author reports on the hospitalization experiences of patients 18 to 38 years old in the psychiatric ward. The sample comes from the psychiatric wards of two general hospitals in the Montréal area (Canada). The data were analyzed using a qualitative method. Empirical categories were inferred from the respondents' discourse based on the broad themes which make up the psychiatric experience: admission; hospital environment and rules; daily life; medication; relations with the staff and leaving the hospital. The results shed light on the suffering, dissatisfaction and ambivalent feelings surrounding the patients' hospital experience. Based on the experience of psychiatric patients, the author identified five processes at work during psychiatric hospitalization.

Adult↗
PubMed2003

Developing user involvement in research.

User involvement is central to the UK government's modernization agenda for the National Health Service (NHS). This paper represents work undertaken for the NHS National Cancer Research and Development Programme and NHS Executive Trent. It includes reflection on the experience of user involvement in health care research drawing on current UK health policy documents and an examination of the factors affecting recruitment to breast cancer clinical trials, and contributes to the debate on recruitment to clinical trials. Reference to UK policy documents is made throughout as well as real life experience of involving users in research. It summarizes key issues that nurses and midwives must consider to ensure effective user participation in research and practice.

Breast Neoplasms↗