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PubMed1992

Scripps Clinic: in transition to the on-line medical record.

The TMI system was implemented at our main campus on March 4, 1991, and at this point we are very pleased with all aspects of system performance. Since the conversion, the number of jobs dictated by our physicians has increased 20%, and we interpret this increase as an objective measure of physician satisfaction with the system. An increasing number of physicians are accessing lab results and documents from home via modem to review the next day's patients or while on-call. Transcription productivity has improved and enthusiasm for the system is high. Requests for chart documentation from our business office have decreased 60% due to the ability to access and print documents directly from the mainframe. The next phase in our information plan involves the installation of the TMI system at our regional clinics and our inpatient transcription unit. Further steps in the transition to on-line medical records, such as the conversion of 600,000 active and archived records, awaits the further development of technology in order to be feasible and cost effective. Our experience has shown that developing complex applications such as the TMI demands perseverance and a willingness to work closely with multiple vendors and products in order to identify the best options in a rapidly developing field. Extensive involvement of end users early in the planning process helped us to secure and implement a system with a high level of user acceptance and satisfaction.

Ambulatory Care Information Systems↗
PubMedDate not supplied

Using Web-based reporting systems to evaluate health promotion: the experience of two statewide HIV prevention programs.

While Web-based reporting systems are becoming more common in public health for disease surveillance and for tracking interventions such as immunizations, their use for program evaluation is relatively new. This article describes two Web-based reporting systems developed to enable local agencies that conduct health promotion activities to enter process and outcome data for their own use, as well as for analysis by researchers and funders. The systems support the three major uses of evaluation: accountability, program improvement, and generating knowledge for the field. Annually, these programs obtain evaluation information on thousands of clients and individual and group sessions. Developing and introducing the Web-based systems was time-consuming and required significant State Health Department and local agency resources. Involvement of end users in the development process was critical to creating responsive systems that were accepted by staff in local agencies. Staff members from grantee agencies responded well to systems, as evidenced by high rates of user compliance (over 90%) and positive reactions (over 80%) on anonymous surveys. Concerns about resistance from contractors to use of the system, based on fears about breaches in client confidentiality or concerns about the difficulty in using the technology, were not borne out.

HIV Infections↗
PubMedDate not supplied

An interdisciplinary, evidence-based process of clinical pathway implementation increases pathway usage.

Clinical pathways have been implemented in many healthcare settings as a link between evidence and practice. Most published research concludes that when clinical pathways are implemented and used by health professionals, there is a positive impact on health outcomes. However, some research also suggests that utilization of clinical pathways by health professionals is low and that implementation strategies for linking evidence with clinical practice often prove to be weak or ineffective. This paper describes a before and after study to determine whether an interdisciplinary, genuinely collaborative, and evidence-based process of clinical pathway implementation resulted in increased documented use of an acute myocardial infarction (AMI) clinical pathway by health professionals in a regional Australian hospital. Underpinning the design and implementation process was the belief that true team involvement would lead to ownership, acceptance, and, ultimately, to increased usage of the pathway. Documented clinical pathway usage was measured in two ways: (1) the presence of the AMI clinical pathway in the medical records of patients diagnosed with an AMI and (2) the proportion of the AMI clinical pathway completed when it was present in the medical record. A total of 195 medical records of those diagnosed with an AMI were audited before (n = 124) and after (n = 71) the implementation process. The interdisciplinary, truly collaborative, and evidence-based implementation process resulted in a statistically significant increase in documented usage of the AMI pathway (22.6% vs. 57.7%; p <.000). Results indicate that involvement of key users in the design and implementation of a clinical pathway significantly increases staff utilization of the document.

Aged↗
PubMed1996

Key strategic challenges facing purchasers of health care--a Scottish perspective.

This paper describes the key strategic challenges facing a purchaser of health care services in central Scotland. The paper describes a number of key issues including influencing the health of the local population, the financial constraints, the development of alliances and the involvement of service users in planning. It highlights the importance of organizational development and the management of the external environment. Long-term challenges associated with the purchase of health care are suggested and the paper concludes that achieving health status targets and the desires of the local population could well conflict. It suggests that health boards/authorities will need to enhance their planning and developmental work for the future.

Contract Services↗
PubMed2004

Evaluating the impact of training in psychosocial interventions: a stakeholder approach to evaluation--part II.

Part I of this article presented an examination of the methodology used in previous psychosocial interventions (PSI) research and the rationale for the collaborative, qualitative design used in this study. In this second article the findings from an evaluation of five short PSI training courses are presented. Findings demonstrated that while the training was positively evaluated by participants and seen to be relevant to practice, the actual dissemination of PSI training into practice was a complex and context dependent process. There was difficulty for course participants in using PSI in practice as discrete, formal interventions. Rather the predominant way participants used PSI in practice was via a process of modifying PSI. The course philosophy, content and mode of delivery impacted on how the respondents constructed PSI as an overall approach to care and working relationships. Participants reported other 'hidden' benefits of training, such as reaffirming practice, increasing confidence and perhaps most powerfully, a change in attitude linked to the importance and impact attached to the service user and carer involvement in delivering the courses. Discussion locates the findings within the findings from previous PSI training evaluations and recommendations are made for a reappraisal of approaches to PSI training and research.

Education↗
PubMed2006

A pilot project to design, implement and evaluate an electronic integrated care pathway.

The project focused on the design, implementation and evaluation of an electronic integrated care pathway (eICP), within a Mother and Baby Unit. Health care professionals and service users (stakeholders) were involved in the process in order to promote patient centred, co-constructed care. Questionnaire and discussion groups were used for data collection regarding the initial eICP development. Of 15 participants who took part in the design and development of the eICP, seven were able to take part in the evaluation process on the Unit. Results show that 100% (n = 7) of the participants were in agreement with the eICP and the format that was produced and implemented for trial on the Unit. Increased ownership of records, greater multi disciplinary involvement and enhanced patient experience were also reported. Recommendations for clinical practice include resource management, ownership of the research group, holism maintenance and the acquisition of computer skills.

Critical Pathways↗
PubMed2003

Ampicillin, gentamicin and teicoplanin as antimicrobial therapy for recurrent Streptococcus agalactiae and Enterococcus faecalis endocarditis in an intravenous drug abuser with HIV infection.

Infective endocarditis associated with human immunodeficiency virus (HIV) infection occurs almost exclusively in intravenous (i.v.) drug users and usually involves the tricuspid valve, with an increased mortality rate among patients with a severe degree of immunosuppression. The first reported case of recurrent tricuspid endocarditis sustained by Streptococcus agalactiae and Enterococcus faecalis in an i.v. drug addict during HIV infection is presented. Antimicrobial therapy with i.v. ampicillin, gentamicin and teicoplanin led to complete clinical and echocardiographical recovery.

Adult↗
PubMed2004

An assessment of the readiness of hospice organizations to accept technological innovation.

We surveyed seven of the 62 certified hospice programmes in the state of Missouri. The survey consisted of 19 questions that covered demographic information, how employees received new information, the current use of various forms of technology, employees' comfort with technology and their perceptions of the use of video-phones. A total of 124 surveys were returned. Respondents were categorized within the following disciplines: nurses (48%), administrators and nurse supervisors (6%), social workers (9%), physicians (3%), home health aids (18%), chaplains (5%) and other staff (e.g. clerical and bereavement staff) (12%). Staff reported using several types of technological device at work but not a video-phone or a Web camera. There were significant differences between hospices in the degree of use of computers at work, the number of devices used at work and the perceived benefits of video-phone technology. There were significant differences between disciplines in the degree of use of computers at work and at home, the number of devices used at work, and their comfort both with the use of new technology and with the idea of introducing new technology to patients and their families. Because there were variations in the perceived usefulness of video-phones for hospice care, the introduction of such equipment would require substantial involvement of the users.

Attitude of Health Personnel↗
PubMed1996

Tapping the television cable.

Immediate access to patient data is essential to support good clinical decision making and support. However, away from the surgery, the doctor is currently unable to have any access to the clinical database. Solutions exist to support remote access, such as modems or radio data networks, but these are slow, with typical speeds in the 2-10 kbaud region. We propose a novel solution, to use the TV cable already installed in many homes. Using this technology, a suitably equipped computer (RF modern) is capable of connecting at speeds in excess of 500 kbaud and will run applications in exactly the same way as if connected to a surgery network: the cable TV becomes a LAN, but on a metropolitan scale. Brunel University, in collaboration with the Cable Corporation, has been piloting such a network. Issues include not only levels of service, but also security on the network and access, since the data are being effectively received in every home. However, close scrutiny of channel use can create closed networks reserved for specific users. The technology involves use of an RF modem to transmit data on a reverse channel (based at 16 MHz) on each subnet to a router at the head end of the cable network. This frequency translates the packet and retransmits it to all the subnets on a forward channel (based at 178 MHz). Each channel occupies the bandwidth normally allocated to one TV channel. Access is based on a modified CSMA/CD protocol, so treating the cable network as single multiple access network. The modem comes as a standard card installed in a PC and appears much as an ethernet card, but at reduced speed. With an NDIS driver it is quite able to support almost any network software, and has successfully demonstrated Novell and TCP/IP. We describe the HomeWorker network and the results from a pilot study being undertaken to determine the performance of the system and its impact on working practice.

Computer Communication Networks↗
PubMedDate not supplied

Breast awareness project for women with a learning disability.

In 1995/6, while conducting a quality assurance evaluation in a residential group home for adults with a learning disability, the subject of breast screening and the importance of early detection of breast abnormalities was raised by a member of staff. At the time, the Mulberry Trust had a quality standard that women between 50 and 64 years who are supported in continuing care should attend breast screening clinics on a 3-yearly basis if they wish. A pilot scheme was devised based on the premise that breast awareness for service users should be promoted. It was decided that the scheme should include a breast examination, conducted on a monthly basis, ideally by the service users themselves, or by suitably trained staff on their behalf. The pilot scheme was implemented using available research and training was provided for qualified nursing staff within the trust. The training covered breast cancer prevention and breast awareness. After 7 months the scheme was evaluated and changes were made to policy and practice, including consultation with the trust's ethics panel regarding implementation of procedures. Training for staff in breast awareness continues and the scheme is slowly being introduced across the trust to enable all service users to be involved, both in residential homes and community settings. However, in future, the emphasis will be on identifying changes in the breast during normal care routines, such as bathing and dressing, as opposed to formal, clinical examination.

Adult↗
PubMedDate not supplied

The four-layer bandage system from a nursing perspective.

This article describes an evaluation that took place in 20 health centres, community clinics and hospitals throughout the UK. The aim was to explore nurses' opinions of three different four-layer bandage systems: kit A (System 4); kit B (Charing Cross); and kit C (Profore). Fifty-seven pairs of nurses were involved; within each pair, one was the applier and one the wearer. Each nurse was asked to complete a questionnaire which highlighted their opinions relating to ease of application, conformability, comfort and preferred bandage length. Responses were analysed using simple frequency counts, means, standard errors, Fisher's exact test and Kruskal-Wallis' one-way analysis of variance. The nurses involved were regular users of either the Charing Cross or Profore systems. Kit A was significantly easier to apply than kit B for layer 1 (P < 0.001), layer 2 (P < 0.05) and layer 3 (P < 0.01). There was no significant difference in relation to layer 4. With regard to ease of application there were no statistically significant differences between kits A and C or B and C. Layer 1 of kit A was significantly more conformable than layer 1 of kit B (P < 0.001). There were no significant differences between kits B and C, or A and C or in relation to comfort for all bandage kits. Overall preference by the applier was: 25 for kit A, nine for kit B and 15 for kit C. Overall preference by the wearer was: 23 for kit A, 10 for kit B and 14 for kit C.

Attitude of Health Personnel↗
PubMedDate not supplied

A survey of 'teamwork' in mental health: is it achievable in practice?

As part of an ENB educational evaluation of teamworking in mental health, a report-and-respond survey was used as one of five data collection methods. This instrument disseminated earlier findings back to the participants and invited further comments. This article discusses the usefulness of this type of survey as a data collection tool and presents the findings of the survey which was administered to service professionals, educationalist, students, users and carers involved in mental health throughout England. The findings show that when groups of professionals are working within increasingly tight financial constraints and increased workloads, multiprofessional teamworking can be scarce in reality. These tensions present issues for nurse education and training at both pre- and post-registration levels in relation to the teaching of, for and about effective teamwork.

Data Collection↗
PubMedDate not supplied

The views of children and their families on being in hospital.

This study aimed to elicit the separate views of children, young people and carers after a period in hospital as an inpatient. Questionnaires were administered to 130 children and their families discharged after a period as hospital inpatients in January 2003. Anonymized data were returned from 50 families. Data analysis indicated that there were differences in the way that the three groups perceived the period of admission. Although parental sleeping and other social arrangements were subject to some critical review, the nursing care experienced by families was highly rated. Although arrangements for discharge were deemed satisfactory, 38% of carers had to wait for medicines to arrive on the ward before they could go home. Only six of the young people felt there ward catered for their age group and five indicated poor levels of privacy. None of the young people indicated that they had used the equipped teenagers' room. Attempts to include the voice of the younger child in this study proved unsatisfactory as parents elected to act as proxies in completing the child-specific questionnaires. Child healthcare professionals attempting to involve all service users in determining optimum levels of care need to consider fully the methods of data collection and their applicability for differing age groups of children. Dependence on adult carers to reflect accurately the voice of the child is not fully satisfactory.

Adolescent↗
PubMed2006

Potential interactions between prescription drugs and complementary and alternative medicines among patients in the emergency department.

STUDY OBJECTIVE: To determine the nature and prevalence of potential interactions between prescription drugs and complementary and alternative medicines (CAMs) and the reasons some patients do not advise their physicians of CAM use. DESIGN: Cross-sectional survey. SETTING: The emergency department of the Royal Melbourne Hospital, a tertiary referral center. PATIENTS: Four hundred four adult patients (>or= 18 yrs) who visited the emergency department between February 1, 2002, and March 31, 2003. Intervention. A specifically designed, self-administered questionnaire, available in seven languages. MEASUREMENTS AND MAIN RESULTS: Main outcome measures were the prevalence of potential prescription drug-CAM interactions and the reasons some patients do not advise their physicians of CAM use. Mean +/- SD patient age was 50.6 +/- 20.0 years; 220 patients were men (54.5%, 95% confidence interval [CI] 49.5-59.4%). When asked about use during the previous year, 275 patients (68.1%, 95% CI 63.2-72.5%) reported having taken a CAM; of these, 138 were also taking a prescription drug. We identified 15 documented potential drug-CAM interactions in nine patients (3.3% of CAM users, 95% CI 1.6-6.3%) and 97 theoretical potential drug-CAM interactions in 51 patients (18.6% of CAM users, 95% CI 14.2-23.8%). Aspirin and warfarin were the most commonly involved drugs. Of CAM users, 197 (71.6%, 95% CI 65.9-76.8%) never informed their physician about CAM use, most frequently because they were not asked. CONCLUSION: The prevalence of potential drug-CAM interactions among patients in the emergency department is considerable, and some of these interactions could be clinically significant. Practitioners should increase their awareness of potential drug-CAM interactions, and education initiatives aimed at encouraging patient-physician discussion of CAM use are recommended, such as a CAM history in their patient evaluation. Further research is required to better determine the clinical significance of drug-CAM interactions.

Adult↗
PubMed1975

Some correlates of drug use among high school youth in a Midwestern rural community.

A study of the correlates of drug use (marijuana, LSD, mescaline, speed) among high school youth in a rural, Midwestern community indicated that peer group factors were the most influential in such behavior. Also, youth from less intact families and whose parents were perceived to use various legal drugs were more prone to drug use. Drug education was seen as not having as significant an impact in differentiating between users and nonusers nor in deterring users from further involvement. In support of previous research, we conclude that drug use is a form of behavior learned through peer and family socialization.

Adolescent↗
PubMed1978

Psychopathology and nonmedical drug use: a comparison of patient and nonpatient drug users.

This investigation examined the hypothesis that high-rate drug use is not always related to high levels of psychological discomfort. High-rate drug users who were actively involved in treatment are compared to a group of high rate drug users who had never been in treatment nor did they desire it at the time of the investigation. Although both groups used drugs with high frequency, actual patterns of drug use differed. Comparison of MMPI and CAPPS data suggested that the patients were experiencing significantly more distress than were nonpatients. The data further suggest that the patient group had a poorer premorbid level of adjustment. Based on these data patterns of drug use, possible implications for treatment are discussed.

Adult↗
PubMed1991

Experts, lies and stereotypes.

In the second of two articles in involving mental health users in service development, Vivien Lindow discusses the Catch-22 of stigma and representativeness.

Attitude of Health Personnel↗