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PubMed2004

The evolution of a radiation safety audit program for a research institution.

Possibly two of the greatest challenges of a radiation safety program are to ensure that all regulatory requirements are being met and to involve the users in maintaining compliance. At the Fred Hutchinson Cancer Research Center (FHCRC), the radiation safety office has developed an audit program that accomplishes these two challenges for the FHCRC ionizing radiation safety program, which has resulted in quality improvements in the laboratory environment and culminated in an excellent State inspection.

Academies and Institutes↗

PubMed1985

Abdominal wall actinomycosis associated with an IUD. A case report.

Abdominal wall actinomycosis without pelvic organ involvement in users of intrauterine contraceptive devices (IUDs) has not been reported on previously. We encountered one such patient, whose uterine cervix was colonized superficially with Actinomyces. We suggest that systemic actinomycosis be included in the differential diagnosis of pain in IUD users when Actinomyces is found on Papanicolaou smears or in endocervical curettings. Such patients should be treated with appropriate antibiotic therapy, especially prior to any surgical intervention.

Abdominal Muscles↗

PubMedDate not supplied

Automatic 3D intersubject registration of MR volumetric data in standardized Talairach space.

OBJECTIVE: In both diagnostic and research applications, the interpretation of MR images of the human brain is facilitated when different data sets can be compared by visual inspection of equivalent anatomical planes. Quantitative analysis with predefined atlas templates often requires the initial alignment of atlas and image planes. Unfortunately, the axial planes acquired during separate scanning sessions are often different in their relative position and orientation, and these slices are not coplanar with those in the atlas. We have developed a completely automatic method to register a given volumetric data set with Talairach stereotaxic coordinate system. MATERIALS AND METHODS: The registration method is based on multi-scale, three-dimensional (3D) cross-correlation with an average (n > 300) MR brain image volume aligned with the Talariach stereotaxic space. Once the data set is re-sampled by the transformation recovered by the algorithm, atlas slices can be directly superimposed on the corresponding slices of the re-sampled volume. the use of such a standardized space also allows the direct comparison, voxel to voxel, of two or more data sets brought into stereotaxic space. RESULTS: With use of a two-tailed Student t test for paired samples, there was no significant difference in the transformation parameters recovered by the automatic algorithm when compared with two manual landmark-based methods (p > 0.1 for all parameters except y-scale, where p > 0.05). Using root-mean-square difference between normalized voxel intensities as an unbiased measure of registration, we show that when estimated and averaged over 60 volumetric MR images in standard space, this measure was 30% lower for the automatic technique than the manual method, indicating better registrations. Likewise, the automatic method showed a 57% reduction in standard deviation, implying a more stable technique. The algorithm is able to recover the transformation even when data are missing from the top or bottom of the volume. CONCLUSION: We present a fully automatic registration method to map volumetric data into stereotaxic space that yields results comparable with those of manually based techniques. The method requires no manual identification of points or contours and therefore does not suffer the drawbacks involved in user intervention such as reproducibility and interobserver variability.

Algorithms↗

PubMed1993

Decentralized testing for prothrombin time and activated partial thromboplastin time using a dry chemistry portable analyzer.

Previous work has established the precision and accuracy of a portable blood coagulation analysis system using paramagnetic particles contained in a dry reagent on a disposable test card. We examined the deployment of this technology in decentralized hospital settings and compared test results obtained in the surgical intensive care unit, coronary care unit, and outpatient cardiology clinic with those obtained in the central laboratory. Nursing personnel were instructed in the use of the system, and quality control testing was performed daily by the laboratory staff. In the intensive care units, patient subjects included those on whom tests of prothrombin time and activated partial thromboplastin time had been ordered. Immediate determinations were performed by the intensive care unit nursing staff on the same citrated, whole-blood samples that were subsequently sent to the central laboratory. In the outpatient cardiology clinic, fingerstick blood samples were obtained for prothrombin time determinations with the dry chemistry system. Paired prothrombin time samples obtained by venipuncture were run in the hospital laboratory. The study involved multiple users, multiple locations, two lots of activated partial thromboplastin time cards, and several different instruments, over an extended period. Correlation coefficients between the dry chemistry system and the hospital laboratory under these conditions were in an acceptable range in all sites studied. We concluded that, with appropriate training and quality assurance, the dry chemistry system provides an acceptable alternative to the hospital laboratory for prothrombin time and activated partial thromboplastin time determinations.

Chemistry Techniques, Analytical↗

PubMed1995

Balancing learner control and realism with specific instructional goals: case studies in fluid balance for nursing students.

In designing instruction, there is an inherent tension between permitting learner control and focusing on specific instructional goals. This tension is particularly problematic in computer-based clinical case studies. In addition, the question of the appropriate level of realistic detail is central to case study design. More learner control and greater detail require greater complexity and interactivity, and consequently longer development time per case. They may also lead to difficulty in focusing on specific content. This program is designed to present computer-based case studies as an adjunct to classroom instruction in a specific content area, with significant compromises in realism compensated by the potential to focus on a specific set of problems and expose students to a fairly large number of "patients." The degree of learner control is necessarily limited by the program's structure, but the design attempts to allow a considerable amount of self-direction within those limits. The program's main path goes through a series of case studies illustrating a variety of fluid and electrolyte problems. These case studies are fairly simple and tightly structured: history, physical assessment, and laboratory data are presented near the beginning of each study, and learners are given predefined choices with immediate feedback at specified decision points. The case studies are designed to be completed fairly rapidly, typically no more than about thirty minutes per case. The distortion of the case study format by the obvious focus on fluid and electrolyte problems is compensated somewhat by inclusion of a number of cases with no relevant problems. Within this structured format, the program gives the learner control over a number of aspects of the learning experience. Hypertext is used hierarchically, with two levels of explanation for some central concepts and one level for material not directly relevant to the main instructional goals. Consequently, the learner controls content density to a considerable degree. Since nursing students are under pressure to absorb large amounts of clinically relevant information within a relatively short time, the availability of additional information on diagnoses, charting abbreviations, normal ranges for lab values, etc., may provide an added incentive to use the program. Though the case studies are linear with no branching, learners have several options in using them. The basic user mode involves simply going through the case studies and "solving" them: evaluating the data, identifying problems, and making basic treatment decisions. Alternatively, the learner may choose a particular problem and use the program as a "semi-tutorial." Backward movement is allowed, either to review the development of a case or to try again after an incorrect response. Accumulated information is available in an on-screen "chart" for ready reference. A "reference library" is accessible for browsing from any point in the program. Learner evaluation of the program is in progress.

Computer Simulation↗

PubMedDate not supplied

Setting clinical standards for care in schizophrenia.

A clinical standards advisory group spent more than two years developing a protocol for assessing standards of care for people with a diagnosis of schizophrenia. The results of its site visits have major implications for nursing practice. There is a clear need for attention to be paid to physical health, medication management and the greater involvement of users and carers. Training in psychosocial interventions needs to be developed as a matter of urgency.

Humans↗

PubMed1996

The lay perspective in health technology assessment.

Health technology assessment has predominantly been carried out by scientific and health policy experts, but the involvement of users is becoming increasingly important. At present, robust examples of the integration of lay knowledge in health technology assessment are limited, but examination of examples in other fields of health policy decision making can provide important pointers for the development of valid methodologies.

Community Participation↗

PubMed1976

Planning for meaningful change in libraries and library networks: a first step.

The Program Planning Model (PPM) is a planning and management tool that facilitates development and acceptance of significant programs. PPM assists program planning by systematically involving consumer or user groups in the development and review of new programs. While user participitation is important throughout PPM, this involvement is especially important during the problem exploration phase, when the problems or needs of these users are surveyed. The Nominal Group Technique (NGT), a variation of the "brainstorming" process, is a structured but flexible group process used in the problem exploration phase to generate a high number of useful responses concerning problem areas. NGT ensures maximum contribution of ideas by all participtants. NGT and its application in the planning and management efforts of several libraries and library networks are described in detail.

Group Processes↗

PubMedDate not supplied

NSAID injury to the small intestine.

PURPOSE: To identify the clinical and radiologic findings in patients with diaphragm-like strictures in the small bowel. PATIENTS AND METHODS: We reviewed the histories, radiologic findings, and pathologic findings in two men and two women, all in their sixties, with a history of long-term nonsteroidal antiinflammatory drug (NSAID) or aspirin (ASA) usage and one or more radiologically demonstrated diaphragm-like strictures in the small bowel. RESULTS: Two patients had long histories of NSAID usage, and two of ASA usage. One NSAID user had a long segment of jejunal involvement, and the other three had short segments of duodenal involvement. The ASA users presented with symptoms of esophageal disease, the small bowel lesions were unexpected, and ASA usage was not initially elicited. In one NSAID user and one ASA user, broader strictures with humps rather than diaphragms were also seen producing a lifesaver-like or bagel-like configuration. CONCLUSIONS: Multiple diaphragm-like strictures can occur in NSAID injury and are pathognomonic except in the rare patient with ulcerative enteritis complicating celiac disease. Single or few diaphragm-like strictures can occur in NSAID injury and peptic ulceration. ASA should be considered an NSAID with regard to small-bowel toxicity. A careful medication history is required when an unexplained small bowel abnormality is seen radiologically, and a dedicated small bowel examination is required when NSAID injury is suspected.

Aged↗

PubMed2005

African American female drug users and HIV risk reduction challenges with criminal involvement.

The main objectives of this paper are to examine the prevalence of criminal involvement among a sample of African American female drug users and to identify factors associated with that criminal involvement, where criminal involvement is defined as having been in jail or prison. Data were collected in Atlanta from 333 adult women at two points in time, namely during baseline assessments conducted prior to their enrollment in an HIV risk reduction intervention and at follow-up assessments conducted 6 months after completion of the intervention. The prevalence and period prevalence of criminal involvement were relatively high. At baseline, 86.8% of the women indicated criminal involvement at some point in their lives and over one-third (37.2%) were involved in the year prior to enrolling into the study. During follow-up interviews, 31.5% reported criminal involvement during the 6 months since enrollment. The findings revealed that victimization/abuse and drug use setting might be salient risk factors for criminal involvement. The unique needs of women such as those in this sample must be taken into account when designing intervention and prevention programs, both within and outside the criminal justice system.

Adolescent↗

PubMed1996

The protective effect of AIDS-related behavioral change among injection drug users: a cross-national study. WHO Multi-Centre Study of AIDS and Injecting Drug Use.

OBJECTIVE: This study assessed the relationship between self-reported acquired immunodeficiency syndrome (AIDS) behavioral change and human immunodeficiency virus (HIV) serostatus among injection drug users. METHODS: The study sample involved 4419 injection drug users recruited from drug abuse treatment and nontreatment settings in 11 cities in North America, South America, Europe, Asia, and Australia. The World Health Organization multisite risk behavior questionnaire was used, and either blood or saliva samples for HIV testing were obtained. Subjects were asked, "Since you first heard about AIDS, have you done anything to avoid getting AIDS?" RESULTS: The protective odds ratio for behavioral change against being infected with HIV was 0.50 (95% confidence interval = 0.42, 0.59). While there was important variation across sites, the relationship remained consistent across both demographic and drug use history subgroups. CONCLUSIONS: Injection drug users are capable of modifying their HIV risk behaviors and reporting accurately on behavioral changes. These behavioral changes are associated with their avoidance of HIV infection.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Correlates of therapeutic involvement among adolescents in residential drug treatment.

The current study addresses the critical need for research on the therapeutic involvement among adolescent substance users in treatment. Although therapeutic involvement (TI) and the services that clients receive during treatment are among the best predictors of treatment retention and through retention associated with better posttreatment outcomes, there are relatively few empirical studies of therapeutic involvement among adolescents in drug treatment. Using data on N=185 adolescent clients in five adolescent residential drug-treatment programs in New Jersey, factor analyses used maximum likelihood extraction and oblique rotation. Pearson's correlation coefficients and multivariate linear regression were used to explore the utility of using existing measures of TI developed on adult populations to examine the correlates of therapeutic involvement among adolescents. The majority of subjects (85%) were between 16 and 18 years of age, with an average age of 17 years. Seventy-nine percent were male, 20% were Hispanic, 36% were African-American, and 46% were Caucasian. Working alliance, self-esteem, spirituality, deviance, and substance use problem severity were associated with therapeutic involvement and there is evidence that there may be important subgroup differences associated with gender and ethnicity. Further research on the interplay between these factors, therapeutic involvement, and recovery among adolescents can inform the development of strategies to enhance the engagement and retention of adolescents in drug treatment.

Adolescent↗

PubMed1992

Clinical and laboratory correlates of human immunodeficiency virus infection in a cohort of intravenous drug users from New York, NY.

BACKGROUND: The human immunodeficiency virus (HIV) epidemic has increasingly involved intravenous drug users. Few studies have attempted to define its clinical and laboratory characteristics in this population. METHODS: We recruited 223 intravenous drug users from New York, NY, for a prospective study of the natural course of HIV infection. Medical history, physical examination, medical staging, and immunologic assessments were performed at 6-month intervals. We examined the baseline findings among this cohort. RESULTS: Of the total cohort, 65.9% were men and 34.1% were women, with 70.9% African American, 12.6% white, 11.7% white Latino, and 4.9% black Latino. At baseline, 44.4% were HIV negative and 55.6% were HIV positive. No significant association was noted between ethnicity, gender, and serologic status. Also no significant difference was noted for homelessness either across serologic status or gender. There was a trend toward an association between gender and use of drugs during the week before interview; the women showed higher drug use. A significant association was noted between HIV serologic status and reported history of pneumonia, oral candidiasis, cough, night sweats, fever, and lymphadenopathy on physical examination. In a regression model, white blood cell count, hematocrit, symptom/sign complex score, and CD4 cell number were significantly associated with HIV status. CONCLUSION: This study provided important historical, clinical, and immunologic characteristics that are useful in the identification and evaluation of the HIV-infected intravenous drug user.

Analysis of Variance↗

PubMed1998

Long-term cannabis use: characteristics of users in an Australian rural area.

AIM: To investigate the characteristics and patterns of cannabis and other drug use among long-term cannabis users in an Australian rural area. DESIGN: Cross-sectional survey of a "snowball" sample of long-term cannabis users. SETTING: The North Coast of New South Wales is an area with high levels of cannabis cultivation and use, and many long-term users. PARTICIPANTS: The study involved 268 long-term cannabis users who had regularly used cannabis for at least 10 years. MEASUREMENTS: A structured interview schedule obtained information on: demographics, social circumstances, patterns of cannabis and other drug use, contexts of use, perceptions about cannabis and legal involvement. FINDINGS: The mean age of the sample was 36 years and 59% were made. The median length of regular cannabis use was 19 years. Most (94%) used two or more times a week and 60% used daily, with a median of two joints per day. Two-thirds (67%) used cannabis in social settings and two-thirds grew cannabis for their own use. The most common reasons for using cannabis were for relaxation or relief of tension (61%) and enjoyment or to feel good (27%). The most commonly reported negative effects were feelings of anxiety, paranoia, or depression (21%), tiredness, lack of motivation and low energy (21%) and effects of smoke on the respiratory system (18%). The majority drank alcohol (79%) and over one-third were drinking at hazardous levels. Most were current (64%) or ex-tobacco smokers (24%). One-quarter (25%) had been charged with possession of cannabis, 11% for cultivation and 6% for supply, with non-drug offences low (8%or less). Overall, three-quarters (72%) believed that the benefits of cannabis use outweighed the risks, 21% felt there was an even balance, and 7% said cannabis had done them more harm than good. CONCLUSIONS: Among long-term cannabis users in this Australian rural area, cannabis use was an integral part of everyday life and it was primarily used in social situations for the same reasons that alcohol use is used in the wider community.

Adult↗

PubMed1999

Collaborative prototyping approaches for ICU decision aid design.

When computer-based aids do not support the human users' decision-making strategies or anticipate the organizational impacts of technological change, advances in information technology may degrade rather than enhance decision-making performance. Such failures suggest the design of human-computer cooperation for problem solving and decision-making must be driven by human cognitive and organizational process requirements rather than computer technology. Decision- and user-centered development techniques involve domain experts and end-users in the earliest phases of design to evolve an understanding of requirements through iterative prototyping. This paper presents a collaborative approach to cognitive systems engineering applied to developing a clinical aid to assist respiratory care in the surgical ICU.

Computer Systems↗

PubMed1993

Sampling a hidden population: noninstitutionalized drug users.

As the spread of AIDS continues, there is an urgent need to understand patterns of drug use among drug users. While it is recognized that probability samples are scientifically preferable, there is a need to balance the realities of field research targeting an elusive population with the need for a sound sampling plan. A purposive or targeted sampling plan can increase the possibility of obtaining a representative sample of drug users. Targeted sampling involves using several sampling methods. First, neighborhoods with high concentrations of drug users are identified within the community in order to identify clusters of individuals in the target population. Once the geographic areas from which to sample have been identified, stratification can be used as an effective way to get a representative sample from neighborhoods with differing drug use patterns. The sampling plan can be further strengthened by the use of quota sampling to ensure that subgroups of drug users are adequately represented in the sample.

Epidemiologic Methods↗

PubMed2005

Using marijuana in adulthood: the experience of a sample of users in Oklahoma City.

This study examines marijuana involvement among a sample of adult users in Oklahoma City, Oklahoma. Semi-structured interviews were conducted with 29 adult marijuana users between 2000 and 2002. Qualitative analyses of data on patterns of marijuana involvement in adulthood were conducted. Marijuana use is a leisure-time activity users engage in with close peers or alone. Adult users limit their consumption of marijuana to free time, and keep their marijuana use from interfering with other responsibilities. These adult users are controlled marijuana users; they view their involvement with marijuana as a personal, private, recreational activity.

Adult↗

PubMed2006

Capturing user requirements in medical device development: the role of ergonomics.

Measuring and fulfilling user requirements during medical device development will result in successful products that improve patient safety, improve device effectiveness and reduce product recalls and modifications. Medical device users are an extremely heterogeneous group and for any one device the users may include patients and their carers as well as various healthcare professionals. There are a number of factors that make capturing user requirements for medical device development challenging including the ethical and research governance involved with studying users as well as the inevitable time and financial constraints. Most ergonomics research methods have been developed in response to such practical constraints and a number of these have potential for medical device development. Some are suitable for specific points in the device cycle such as contextual inquiry and ethnography. Others, such as usability tests and focus groups, may be used throughout development. When designing user research there are a number of factors that may affect the quality of data collected, including the sample of users studied, the use of proxies instead of real end-users and the context in which the research is performed. As different methods are effective in identifying different types of data, ideally more than one method should be used at each point in development. However, financial and time factors may often constrain this.

Equipment Design↗