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PubMed1995

FDDI information management system for centralizing interactive, computerized multimedia clinical experiences in pediatric rheumatology/Immunology.

This paper describes the design, authoring, and development of interactive, computerized, multimedia clinical simulations in pediatric rheumatology/immunology and related musculoskeletal diseases, the development and implementation of a high speed information management system for their centralized storage and distribution, and analytical methods for evaluating the total system's educational impact on medical students and pediatric residents. An FDDI fiber optic network with client/server/host architecture is the core. The server houses digitized audio, still-image video clips and text files. A host station houses the DB2/2 database containing case-associated labels and information. Cases can be accessed from any workstation via a customized interface in AVA/2 written specifically for this application. OS/2 Presentation Manager controls, written in C, are incorporated into the interface. This interface allows SQL searches and retrievals of cases and case materials. In addition to providing user-directed clinical experiences, this centralized information management system provides designated faculty with the ability to add audio notes and visual pointers to image files. Users may browse through case materials, mark selected ones and download them for utilization in lectures or for editing and converting into 35mm slides.

Allergy and Immunology↗

PubMed1983

A washbasin for washing when seated. An example of a user-oriented development project: a study in systematic design based on ergonomics principles.

This article describes an example of innovative product development. The development process possesses features which we believe are essential for encouraging innovation which is user oriented. One aim of this article is to show and discuss the multitude of activities required if the aim is not only to carry out ergonomic research but also to create innovations based on ergonomics principles. A further aim is to focus attention on some 'ergonomic' aspects of the innovation process itself. The description in the paper follows the sequential steps of the development model used. For each step a brief factual description is given. There is also a general discussion of methodological points. The project has resulted in a new and different product which is now successfully in commercial production. The concluding discussion contains a summary of the main methodological experiences and points. These are: A development project started from, and oriented towards, use and user problems can result in a product which is different from and functionally superior to those developed in more traditional ways. An ability to extract, handle and transform user experiences in systematic ways needs to be developed. Much user knowledge is now discarded as being unmanageable. Methods for the practical evaluation of prototypes at an early stage in development are missing and the potential of such work is neglected. Methods to describe the costs and benefits of ergonomics development can, and should be, used to supply arguments in favour of the product at hand.

Journal Article↗

PubMed1992

Prompt comprehension in UNIX command production.

We hypothesize that a cognitive analysis based on the construction-integration theory of comprehension (Kintsch, 1988) can predict what is difficult about generating complex composite commands in the UNIX operating system. We provide empirical support for assumptions of the Doane, Kintsch, and Polson (1989, 1990) construction-integration model for generating complex commands in UNIX. We asked users whose UNIX experience varied to produce complex UNIX commands, and then provided help prompts whenever the commands that they produced were erroneous. The help prompts were designed to assist subjects with respect to both the knowledge and the memory processes that our UNIX modeling efforts have suggested are lacking in less expert users. It appears that experts respond to different prompts than do novices. Expert performance is helped by the presentation of abstract information, whereas novice and intermediate performance is modified by presentation of concrete information. Second, while presentation of specific prompts helps less expert subjects, they do not provide sufficient information to obtain correct performance. Our analyses suggest that information about the ordering of commands is required to help the less expert with both knowledge and memory load problems in a manner consistent with skill acquisition theories.

Computer Simulation↗

PubMed1989

[The reproduction of eperythrozoonosis of swine by animal experiments after splenectomy].

An account is given in this paper of equipment, techniques, clinical tests, and investigations for laboratory diagnosis required for an animal experiment on splenectomised store pigs suspicious of eperythrozoonosis (EEZ). The clinical, bacterioscopic, haematological, and biochemical data recorded from the experiment on splenectomised store pigs with suspicion of EEZ were helpful in reproducing both symptoms indicative of EEZ and relevant parameters of laboratory diagnosis. The diagnosis of EEZ, made in the first place on the basis of clinical, bacterioscopic, and haematological findings, was thus confirmed. Conclusions of general validity for users of animal experiments for EEZ diagnosis were also drawn and will prove helpful in establishing safe diagnosis in dubious cases. The animal experiment proved useful in following up the interactions between all parameters checked, which will contribute, no doubt, to better understanding of the pathophysiological processes associated with this disease.

Anaplasmataceae Infections↗

PubMed1999

Striatal dopaminergic abnormalities in human cocaine users.

OBJECTIVE: Previous human postmortem experiments have shown an abnormally high number of dopamine uptake sites in the striatum of chronic cocaine users, which might contribute to cocaine withdrawal symptoms such as depression and suicidality. Previous inconsistencies in results were perhaps related to selective radioligand affinity changes or a coexisting loss of dopamine neurons. METHOD: In the present study, binding of the cocaine analog [3H]WIN 35428 to the dopamine transporter was assayed in postmortem striatal samples from 15 cocaine-using subjects and 15 matched comparison subjects to determine whether there were differences in number of binding sites or in affinity. Binding to the vesicular monoamine transporter, a measure of total dopaminergic terminals, was also assessed by using the radioligand (+)-[3H]dihydrotetrabenazine (DTBZ). RESULTS: Striatal [3H]WIN 35428 binding sites were significantly more numerous in the cocaine users: the mean Bmax value was 9.0 fmol bound/microg protein (SD = 2.8) for the cocaine users but only 6.0 (SD = 1.7) for the comparison subjects. Severity of chronic cocaine use was significantly related to [3H]WIN 35428 binding level. [3H]DTBZ binding was significantly lower in the cocaine users (mean = 330 nCi/mg, SD = 42) than in the comparison subjects (mean = 374, SD = 68). CONCLUSIONS: The present results confirm that cocaine users have a high number of dopamine transporter binding sites on dopaminergic neurons, despite an apparent low number of total dopamine terminals. These abnormalities may contribute to the abnormalities in subjective experience and behavior characteristic of chronic cocaine abusers.

Adolescent↗

PubMed1998

Experience of non-fatal overdose among heroin users in Adelaide, Australia: circumstances and risk perceptions.

AIMS: To ascertain the prevalence and risk factors for non-fatal overdose among heroin users to assist in the development of an effective intervention. DESIGN: Cross-sectional design. SETTING: Community setting, principally metropolitan Adelaide. PARTICIPANTS: Current heroin users (used heroin in the previous six months). MEASUREMENTS: A structured questionnaire including the Severity of Dependence Scale. FINDING: Of 218 current South Australian heroin users interviewed in 1996, 48% had experienced at least one non-fatal overdose their life-time (median: two overdoses), and 11% had overdosed in the previous 6 months. At some time, 70% had been present at someone else's overdose (median: three overdoses). At the time of their own most recent overdose, 52% had been using central nervous system depressants in addition to heroin, principally benzodiazepines (33%) and/or alcohol (22%). The majority of overdoses occurred in a private home (81%) and in the presence of other people (88%). Unrealistic optimism regarding the risk of overdose was evident across the sample. Despite almost half the sample reporting having had an overdose, and the belief expressed by respondents that on average about 50% of regular heroin users would overdose during their life-time 73% had, during the previous 6 months, "rarely" or "never" worried about possibly overdosing. Optimism regarding the possibility of future overdose was reduced in those with recent experience of overdose in comparison to the rest of the sample. A targeted intervention aimed at the reduction of overdose among heroin users is outlined.

Adolescent↗

PubMed2004

Value of the clinical history for different users of dermoscopy compared with results of digital image analysis.

BACKGROUND: The clinical history of a given pigmented lesion could influence the therapeutic decision. Teledermatology and automated image analysis also hold great potential for revolutionizing dermatology services. AIM: The aim of this retrospective study was to evaluate the diagnostic accuracy of users with different experiences in dermoscopy with and without information about patients and their history compared with classification by an automated analysing system. SETTING: One hundred and fifty-seven dermoscopic images of pigmented lesions, taken and proved by histopathology at the Pigmented Lesions Clinic of the Department of Dermatology of the University Tuebingen, Germany, were included. METHODS: All images were viewed by three investigators with different experience: excellent (A), average (B) and beginner (C). In the first dermoscopic classification, no information was available. After 3 months the same images were once more classified by the three investigators, now with the information about the patients and their history. The melanocytic lesions were tested by the Tuebinger Mole Analyser. RESULTS: For user A the sensitivity, specificity and diagnostic accuracy revealed no improvement on including the history (81.3% to 84.4%, 94.6% to 92.3% and 92.0% to 90.7%), whereas user B clearly improved his results (75.0% to 87.5%, 76.9% to 88.5% and 76.5% to 88.3%). No change in the sensitivity was seen by user C (84.4%), but there was a clear improvement in the specificity (69.2% to 87.7%) and diagnostic accuracy (72.2% to 87.0%). Using the computer algorithm, a sensitivity of 100%, a specificity of 76.9% and a diagnostic accuracy of 81.9% were achieved. CONCLUSIONS: The study revealed results relevant to the use of dermoscopy: (1) continuing dermoscopic education influences the diagnostic accuracy; (2) the history is helpful for averaged users and beginners in dermoscopy; (3) digital image analysis has the highest sensitivity, but a lower specificity compared to the clinicians; and (4) digital dermoscopy could be used for store-and-forward systems in teledermoscopy.

Adolescent↗

PubMed2001

"Burnout" and substance user treatment: the phenomenon and the administrator-clinician's experience.

"Burnout" began to be identified in the mid-1970s in the substance user treatment field with the meaning being that one's "fuel" to continue such work was essentially exhausted. "Burnout" is mostly manifest by emotional exhaustion and sometimes by various physical and psychiatric symptoms. In substance user treatment staff there is more "burnout" with more work pressure, unclear work policies, and decreased coping ability, with some "burnout" protection from peer and supervisor support. "Burnout" adversely effects substance user treatment and other human service interventions, with increased absenteeism and job turnover, and it appears to be helped with a variety of methods, including diversity of supports and interests. A case study of the author's substance user treatment and administrative work from the perspective of "burnout" considerations is included.

Burnout, Professional↗

PubMed2001

Development and implementation of an EPR: how to encourage the user.

This paper reports on the role users played in the design and development of an electronic patient record. Two key users participated in the project team. All future users received questionnaires and a selection of them was interviewed. Before starting the development of the EPR, the attitude of users towards electronic record keeping, their satisfaction with the paper clinical records, their knowledge of computers, and their needs and expectations of computer applications in health care were measured by means of a questionnaire. The results of the questionnaire were supplemented with in-depth interviews. Users had a neutral attitude towards electronic record keeping. They were more positive about data entry of the paper records than data retrieval. During the development phase, but prior to the implementation of the EPR, a second questionnaire measured satisfaction with the paper records. Satisfaction appeared to be related to self-rated computer experience. Inexperienced computer users tended to be more positive about the paper records. In general, respondents did not have many expectations about electronic record keeping. A second series of interviews zoomed in on the expectations users had. Except for more concise reporting no beneficial effects of electronic record keeping were expected.

Adult↗

PubMed2003

Methods and pitfalls in searching drug safety databases utilising the Medical Dictionary for Regulatory Activities (MedDRA).

The Medical Dictionary for Regulatory Activities (MedDRA) is a unified standard terminology for recording and reporting adverse drug event data. Its introduction is widely seen as a significant improvement on the previous situation, where a multitude of terminologies of widely varying scope and quality were in use. However, there are some complexities that may cause difficulties, and these will form the focus for this paper. Two methods of searching MedDRA-coded databases are described: searching based on term selection from all of MedDRA and searching based on terms in the safety database. There are several potential traps for the unwary in safety searches. There may be multiple locations of relevant terms within a system organ class (SOC) and lack of recognition of appropriate group terms; the user may think that group terms are more inclusive than is the case. MedDRA may distribute terms relevant to one medical condition across several primary SOCs. If the database supports the MedDRA model, it is possible to perform multiaxial searching: while this may help find terms that might have been missed, it is still necessary to consider the entire contents of the SOCs to find all relevant terms and there are many instances of incomplete secondary linkages. It is important to adjust for multiaxiality if data are presented using primary and secondary locations. Other sources for errors in searching are non-intuitive placement and the selection of terms as preferred terms (PTs) that may not be widely recognised. Some MedDRA rules could also result in errors in data retrieval if the individual is unaware of these: in particular, the lack of multiaxial linkages for the Investigations SOC, Social circumstances SOC and Surgical and medical procedures SOC and the requirement that a PT may only be present under one High Level Term (HLT) and one High Level Group Term (HLGT) within any single SOC. Special Search Categories (collections of PTs assembled from various SOCs by searching all of MedDRA) are limited by the small number available and by lack of clarity about criteria applied in their construction. Difficulties in database searching may be addressed by suitable user training and experience, and by central reporting of detected deficiencies in MedDRA. Other remedies may include regulatory guidance on implementation and use of MedDRA. Further systematic review of MedDRA is needed and generation of standardised searches that may be used 'off the shelf' will help, particularly where the same search is performed repeatedly on multiple data sets. Until these enhancements are widely available, MedDRA users should take great care when searching a safety database to ensure that cases are not inadvertently missed.

Adverse Drug Reaction Reporting Systems↗

PubMed2005

Integrating relevance feedback techniques for image retrieval using reinforcement learning.

Relevance feedback (RF) is an interactive process which refines the retrievals to a particular query by utilizing the user's feedback on previously retrieved results. Most researchers strive to develop new RF techniques and ignore the advantages of existing ones. In this paper, we propose an image relevance reinforcement learning (IRRL) model for integrating existing RF techniques in a content-based image retrieval system. Various integration schemes are presented and a long-term shared memory is used to exploit the retrieval experience from multiple users. Also, a concept digesting method is proposed to reduce the complexity of storage demand. The experimental results manifest that the integration of multiple RF approaches gives better retrieval performance than using one RF technique alone, and that the sharing of relevance knowledge between multiple query sessions significantly improves the performance. Further, the storage demand is significantly reduced by the concept digesting technique. This shows the scalability of the proposed model with the increasing-size of database.

Algorithms↗

PubMed2002

Adolescents with mental health problems: what do they say about health services?

This study explored the health-related views and experiences of adolescent users of mental health services through semi-structured interviews with 32 14-20-year olds who had been diagnosed with a mental illness. The majority of respondents had both negative and positive things to say about their contact with health services. These relate to: the doctor-patient relationship, treatment received, the health-care system, and the environs of the hospital or clinic. The views and experiences of young people with regard to their health care must be taken into account in efforts to boost help-seeking, attendance and compliance rates and, generally, to improve child and adolescent mental health services. In particular, further attention needs to be given to the development of empathic communication skills by health professionals working with adolescents with mental health problems. Work on the health-related views and experiences of representative samples of young people with mental health problems should be prioritized.

Adolescent↗

PubMed2002

Asynchronous web-based patient-centered home telemedicine system.

A web-based system for asynchronous multimedia messaging between shoulder replacement surgery patients at home and their surgeons was developed and tested. A web browser plug-in simplifies the process of capturing video and transferring it to a web site for novice computer users. The design of the video capture plug-in can be reused to acquire and securely transfer any type of data over the web. For example, readings from home biosensor instruments (e.g., glucometers and spirometers) that can be connected to a personal computer can be transferred to a home telemedicine web site. Both patients and doctors can access this web site to monitor health status longitudinally. Six patients, whose familiarity with computers ranged from no experience to expert users, used the system. All of the subjects were able to use the system to check treatment reminders and to send at least one message with video to their surgeons. The surgeons monitored the system regularly and always responded to messages within 24 h during the six-month trial period.

Arthroplasty, Replacement↗

PubMed1991

The new FAA national automated ECG network: some aviation medical examiner experiences.

The Federal Aviation Administration (FAA) has required, since August 1, 1987, that aviation medical examiners (AMEs) transmit by telephone all electrocardiograms (ECGs) necessary for airman "Class I" medical certification. This relatively new airman certification requirement is centralized at the Civil Aeromedical Institute (CAMI) in Oklahoma City. In calendar year 1989, the FAA received 69,000 electronically transmitted electrocardiograms. CAMI uses Marquette Electronics software to interpret the ECG signals that are received from multi-channel equipment. The single-channel transmitted ECGs are hand screened at present. The FAA "automated" screening program is unique among governmental airman medical certification programs throughout the world. This paper presents, for potential future users, the authors' experiences with the new airman automated electrocardiographic certification requirement, and covers positive and negative features involved in the implementation and operation of the program. We conclude that while the new FAA automated ECG screening program has satisfactorily replaced the former "physician-intensive" manual screening process, the new system increases the AME's equipment and operation costs. These are passed on to the airman who is seeking certification.

Aerospace Medicine↗

PubMedDate not supplied

Women opiate users' perceptions of treatment services in New York City.

This paper focuses on the treatment experiences of women opiate users in New York City. Historically, drug research has used male samples, and drug treatment programs have been based upon the concerns of men. Treatment counselors and administrators are typically male, and female clients are frequently outnumbered by male clients. In addition, unique needs of women are not addressed. Primary among these needs is child care, a provision that is not a standard feature of most programs. Additionally, many women opiate users may be in dysfunctional families and/or have histories of sexual victimization that may require special counselling. Using data from 208 women drug users who had been in an opiate treatment program, this paper examines their perceptions of the extent to which these programs incorporate women's distinctive concerns and the degree to which such provisions are affected by the perceived numbers of women clients in these programs.

Adolescent↗

PubMed1984

Effects of caffeine use and ingestion on a protracted visual vigilance task.

College students (12 female, 12 male) were assigned to either higher caffeine user (HCU) or lower caffeine user (LCU) groups based on a caffeine usage survey. Prior to testing, subjects ingested either placebo or 195 or 325 mg caffeine. They then performed a visual vigilance task measuring response blocks, discrete responses (hits and false alarms), reaction times, and a Mood Check List using a double-blind design. HCU made significantly fewer hits, more false alarms, and also responded faster than LCU. No significant main effects of caffeine administration were found. In the mood analyses, male subjects were more anxious at the end of the experiment. Overall, the user factor (HCU versus LCU) was the most potent experimental variable.

Adolescent↗

PubMed2006

Computer-assisted surgery of the paranasal sinuses: technical and clinical experience with 368 patients, using the Vector Vision Compact system.

INTRODUCTION: This paper presents our experience with a navigation system for functional endoscopic sinus surgery. In this study, we took particular note of the surgical indications and risks and the measurement precision and preparation time required, and we present one brief case report as an example. MATERIALS AND METHODS: Between 2000 and 2004, we performed functional endoscopic sinus surgery on 368 patients at the Ludwig Maximilians University, Munich, Germany. We used the Vector Vision Compact system (BrainLAB) with laser registration. The indications for surgery ranged from severe nasal polyps and chronic sinusitis to malignant tumours of the paranasal sinuses and skull base. RESULTS: The time needed for data preparation was less than five minutes. The time required for preparation and patient registration depended on the method used and the experience of the user. In the later cases, it took 11 minutes on average, using Z-Touch registration. The clinical plausibility test produced an average deviation of 1.3 mm. The complications of system use comprised one intra-operative re-registration (18 per cent) and one complete failure (5 per cent). Despite the assistance of an accurate working computer, the anterior ethmoidal artery was incised in one case. However, in all 368 cases, we experienced no cerebrospinal fluid leaks, optic nerve lesions, retrobulbar haematomas or intracerebral bleeding. There were no deaths. DISCUSSION: From our experience with computer-guided surgical procedures, we conclude that computer-guided navigational systems are so accurate that the risk of misleading the surgeon is minimal. In the future, their use in certain specialized procedures will be not only sensible but mandatory. We recommend their use not only in difficult surgical situations but also in routine procedures and for surgical training.

Adolescent↗

PubMed2005

Experience of hepatitis C among current or former heroin users attending general practice.

The majority of injecting drug users in Ireland are infected with hepatitis C (HCV) and many attend general practice for methadone maintenance treatment. To describe awareness and experience of HCV infection, related investigations and treatment, a semi-qualitative interview study of current or former heroin users attending a general practice was carried out. Twenty-five patients (69% of total) were interviewed, of whom 23 were on methadone maintenance therapy at the time of the interview and 22 were HCV positive. While awareness of harm reduction measures and health implications of the infection was good, continued high-risk activity was common. Negative experiences at diagnosis, of subsequent investigations and treatments received were common. Only one person had been treated for HCV. We conclude there are a number of barriers to effective HCV management among heroin users and further research is needed to improve our understanding of this issue.

Adolescent↗