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PubMed1992

Performance over time with a nucleus or Ineraid cochlear implant.

This investigation determined whether the audiological performance of cochlear implant users varied with experience. Thirteen Nucleus and 14 Ineraid subjects were evaluated at 1, 9, and 18 mo after cochlear implant connection. Ten Nucleus and five Ineraid subjects were tested at 30 mo. On average, the ability of the subjects to recognize words and phonemes in an audition-only condition improved during the first 9 mo, as did their ability to recognize spondees in noise. The phoneme scores continued to improve during the next 9 mo. Environmental sound recognition improved gradually; significant improvement from the 1 mo scores was not noted until 18 mo. About half of the subjects who demonstrated poor word recognition at 1 mo showed significantly improved percent word correct scores by 18 mo. The Nucleus and Ineraid subjects did not differ in their patterns of change over time. An information transmission analysis performed on the subjects' consonant confusion matrices showed relatively little change for the nasality and place features during the first 18 mo, and relatively large change for the voice, duration, and frication features. Most improvement in the feature scores occurred during the first 9 mo.

Cochlear Implants↗

PubMed2001

The emergency medicine department system: a study of the effects of computerization on the quality of medical records.

A template based computerized medical record system known as the Emergency Medicine Department System (EMDS) was installed in the emergency department of the National University Hospital, Singapore, replacing handwritten records. A study was carried out to show how the implementation of the EMDS improved the quality of medical records. A retrospective review of old manual records and the ones generated by the EMDS was done by means of a scoring system. The raw scores represent the amount of information captured. The calculated means of scores were then used to compare the records. It was found that EMDS improves the quantity of data capture over the old records in all sections compared. This was seen regardless of the experience of the user. The use of a non-structured generic template results in less data captured compared with a structured symptom-specific template. The design of questions has a great influence in that a double-choice question captures more data than single-choice questions. Building in 'locking' or enforcement mechanisms in the EMDS also helped achieve almost full capture of critical information, such as examination time.

Chest Pain↗

PubMed2004

The synchrotron powder diffractometer at beamline B2 at HASYLAB/DESY: status and capabilities.

The synchrotron powder diffraction beamline B2 at HASYLAB/DESY is described. The beamline is capable of high-resolution powder diffraction as well as time-resolved studies and offers several sophisticated ancillary equipments for special applications. A newly developed image-plate system allows for kinetic studies with good resolution in the minutes range. Numerous sample environments allow for various standard applications including structure solution, kinetic studies and in situ observations under flexible and well defined conditions. Representative examples are shown for these setups, which are also supported for experiments of external users.

Journal Article↗

PubMed1997

Calibration and application of an X-ray image intensifier/ charge-coupled device detector for monochromatic macromolecular crystallography.

Charge-coupled device (CCD)-based X-ray detectors allow data to be collected much more quickly (approximately 10 times) than with current on-line imaging-plate systems. At the ESRF, X-ray image intensifier/CCD detector systems have been developed. These have great potential as fast read-out detectors for macromolecular and other forms of crystallography. They are relatively large sensitive X-ray detectors but have two inherent weaknesses: convex detection surfaces leading to spatial distortion and non-uniformity of intensity response, and susceptibility to small changes in magnetic fields. A large improvement has been made to the accuracy obtained by non-uniformity of response calibration and correction, using fluorescence from doped lithium borate glasses. Monochromatic macromolecular crystallography demonstration experiments with external user groups have shown that high-quality results may be obtained under real experimental conditions.

Journal Article↗

PubMed2006

Personalised social care for adults with disabilities: a problematic concept for frontline practice.

This paper explores the complexities and contradictions of frontline practice that pose problems for personalised social care through enhanced choice. It draws on semi-structured interviews with community care workers, social workers, occupational therapists and care managers in a social service department. Practitioners interviewed were asked about their current assessment and documentation system, including the assessment documents currently used; how they approached information gathering and the topics they explored with service users; and their experience of documenting assessment and care management. The paper argues that the validity and sustainability of personalised social care in frontline practice relies on developing a thorough understanding of the complex and implicit assessment processes operating at the service user/practitioner interface and the inevitable tensions that arise for practitioners associated with the organisational context and broader service environment. The findings demonstrate the variability among practitioners in how they collect information and more importantly, the critical role practitioners occupy in determining the kinds of topics to be explored during the assessment process. In so doing, it shows how practitioners can exert control over the decision-making process. More importantly, it provides some insight into how such processes are shaped by the constraints of the organisational context and broader service environment. Complexities and contradictions may be an inherent part of frontline practice. The issues discussed in this paper, however, highlight potential areas that might be targeted in conjunction with implementing personalised social care through enhanced choice for people with disabilities.

Adult↗

PubMed2004

Pathways to care in first episode psychosis.

In order to inform the development of appropriate local services for early intervention in psychosis, a survey was conducted of the experiences of service users and their carers at the time when signs of psychosis were first noted. Eighteen service users and 12 carers were surveyed by questionnaire and interview. Both service users and carers recognized early signs of psychosis, but were often frustrated in their attempts to find help, particularly by lack of knowledge of whom to approach and unhelpful responses from professionals. The consistent themes that emerged included the young age of onset (mean age 17.2 years), poor recognition and lack of appropriate treatment at an early stage in primary care, delay in treatment because of associated substance misuse, and the inappropriateness of admission to a general adult psychiatric ward. This survey has given a local context to findings from national and international research studies. This will enable us to set up a local service which is responsive to the views and needs of service users and carers in Rotherham.

Adolescent↗

PubMed2005

Photodynamic therapy: new treatment for therapy-resistant plantar warts.

BACKGROUND: Plantar wart treatment remains a challenging one. Various treatment modalities have been previously used and are still in current use. The problem remains in the degree of response to these treatments and the side effects associated with them. OBJECTIVE: The aim of this study was to test a new treatment modality for therapy-resistant plantar warts. METHODS: Thirty-one patients with 48 plantar warts were randomly selected from the Department of Laser Therapy, Medical Centre Maastricht, The Netherlands. The mean age of the patients was 29 years (range 6-74 years). The mean incubation time was 6.8 hours, and the mean treatment time was 18.7 minutes per wart. Each wart was treated an average of 2.3 times, with a median fluence of 100 cm2. RESULTS: Forty-two of 48 (88%) warts showed a complete response. A trend was found between total clearance and size of the warts, age of the patient, and the mean treatment time. No significant side effects were seen postoperatively. CONCLUSION: This study showed that recalcitrant plantar warts were successfully treated with no significant side effects; however, the user needs sufficient experience for this new effective treatment application.

Adolescent↗

PubMed2000

Knowledge representation and indexing using the unified medical language system.

Ontologies and semantic frameworks can be used to improve the accuracy and expressiveness of natural language processing for the purpose of extracting meaning from technical documents. This is especially true when a rich ontology such as the Unified Medical Language System (UMLS) is available. This paper reports on some tools being developed to make this possible and on some experience with a user interface based on ontologies and semantic networks that allows for interactive knowledge exploration.

Abstracting and Indexing↗

PubMed1981

Benzodiazepine withdrawal phenomena.

A withdrawal syndrome is described in 10 patients who claimed to be unable to discontinue benzodiazepines. A high dose group took the equivalent of a mean of 135 mg diazepam/day, and the normal dose group of 20 mg/day. Associated with the gradual reduction of medication was the emergence of severe symptoms of anxiety as well as sensory intolerance, perceptual disturbances and weight loss. The withdrawal syndrome subsided after 2 weeks and was similar in both groups of patients. EEG changes were detected on withdrawal opposite to those known to be associated with initiation of diazepam treatment. The measures tended to revert to the baseline after a drug-free period. One reason why chronic users of diazepam experience difficulty in stopping medication may be the development of a withdrawal syndrome even after moderate dosage.

Adult↗

PubMed2003

Speeding up backpropagation using multiobjective evolutionary algorithms.

The use of backpropagation for training artificial neural networks (ANNs) is usually associated with a long training process. The user needs to experiment with a number of network architectures; with larger networks, more computational cost in terms of training time is required. The objective of this letter is to present an optimization algorithm, comprising a multiobjective evolutionary algorithm and a gradient-based local search. In the rest of the letter, this is referred to as the memetic Pareto artificial neural network algorithm for training ANNs. The evolutionary approach is used to train the network and simultaneously optimize its architecture. The result is a set of networks, with each network in the set attempting to optimize both the training error and the architecture. We also present a self-adaptive version with lower computational cost. We show empirically that the proposed method is capable of reducing the training time compared to gradient-based techniques.

Algorithms↗

PubMed2004

Endovascular stents: market vigilance and risk factors.

With the aim of enhancing the safety and reliability level of coronary stents, we analyzed data collected from accident reports drawn from the MAUDE database (Manufacturer and User Facility Device Experience Database) of the FDA from 1996 to 2000. This analysis allowed us to highlight problems related to the use of coronary stents by means of the analysis of these reports at different levels, beginning from the causes that can lead to a certain type of accident up to the possible complication related to that event. Moreover we analyzed the procedure outcomes in terms of stent position inside the patient's body and the possible therapies adopted to solve the problems. The results showed that the most probable event that can lead to an accident is the stent separation from the balloon which, alone, turns up in a number of cases equal to the sum of all the others. This result highlights the importance of the technical skill of the operators accomplished by special training and of the importance of clarity and completeness in the instructions for the use of the device. Another critical point is the reliability of the device which must guarantee an adequate safety level when it is used according to the instructions.

Angioplasty, Balloon, Coronary↗

PubMed2005

Breast pump adverse events: reports to the food and drug administration.

Breast pumps are medical devices used to express milk and maintain the milk supply. The purpose of this study was to characterize adverse events reported to the United States Food and Drug Administration (FDA) on breast pumps. Thirty-seven adverse event reports on breast pumps were identified from the Manufacturer and User Facility Device Experience database between 1992 and 2003. Four additional reports were found in the Device Experience Network database from 1992 to 1996. The most commonly reported adverse events for electric breast pumps were pain, soreness, or discomfort; the need for medical intervention; and breast tissue damage. Most frequently reported problems for manual breast pumps were breast tissue damage and infection. Contamination of breast milk during pumping was also reported. Breast pump adverse events are likely underreported to the FDA. Reporting adverse events is important for improving the design and manufacture of breast pumps and subsequently decreasing adverse events.

Adult↗

PubMed2004

Cover up or cool it? Sexual intercourse during therapy for bacterial sexually transmitted infections--a discussion of evidence for efficacy of condom use preventing transmission during an acute bacterial STI.

Effective treatment of sexually transmitted infections (STIs) such as gonorrhoea and chlamydia needs sexual behaviour modification, in addition to antibiotics, to protect the index patient and their sexual partner from re-infection during treatment. This may mean advice to avoid sex, or to use condoms for intercourse, until all current sexual partners have completed treatment. This article discusses the effectiveness of condoms as re-infection protection during therapy of gonorrhoea and chlamydial infection. Indirect evidence from studies on primary prevention indicates that, although physically, condoms are impermeable to STI pathogens, the risk of failure depends on the experience of the user and the frequency of use. Health care workers may over-estimate the protective value of condoms in this situation. Patients should be made aware of the risk of infection present, even in experienced condom users, if they choose to continue protected sexual intercourse during therapy for acute bacterial STIs.

Coitus↗

PubMed2000

An exploration of health beliefs, lifestyle behaviours, and health needs of the London-based Greek Cypriot community.

This article reports selected results of the qualitative phase of a multimethod study into an investigation of the health beliefs, lifestyle behaviours, and health status of Greek Cypriots living in London. Data for this phase, which involved 79 informants, were collected through group and individual semistructured interviews. Six major themes were identified. These detail the informants' health and illness beliefs and use of folk remedies. The importance of the family as both a force for health and a cause for health problems is discussed. The informants' experiences as health users are also reported. The article concludes that culture is an important mediator for the health of this ethnic group. Culturally competent care depends on the nurses' understanding of the cultural background of their patients. The article recommends that nurses must be aware of the importance of societal and institutional structures that may discriminate against people from minority ethnic groups.

Adult↗

PubMed2004

Motor rehabilitation using virtual reality.

Virtual Reality (VR) provides a unique medium suited to the achievement of several requirements for effective rehabilitation intervention. Specifically, therapy can be provided within a functional, purposeful and motivating context. Many VR applications present opportunities for individuals to participate in experiences, which are engaging and rewarding. In addition to the value of the rehabilitation experience for the user, both therapists and users benefit from the ability to readily grade and document the therapeutic intervention using various systems. In VR, advanced technologies are used to produce simulated, interactive and multi-dimensional environments. Visual interfaces including desktop monitors and head-mounted displays (HMDs), haptic interfaces, and real-time motion tracking devices are used to create environments allowing users to interact with images and virtual objects in real-time through multiple sensory modalities. Opportunities for object manipulation and body movement through virtual space provide frameworks that, in varying degrees, are perceived as comparable to similar opportunities in the real world. This paper reviews current work on motor rehabilitation using virtual environments and virtual reality and where possible, compares outcomes with those achieved in real-world applications.

Journal Article↗

PubMedDate not supplied

Self-advocacy skills workshop: a report.

This article is a report on a 3-day workshop for adults with a learning disability. The group work described formed part of the annual Self-Advocacy Skills Workshop held at the Hayes Conference Centre, Swanwick, Derbyshire. This year's workshop took place on 7-10 January 1996. It is suggested that user-oriented events have a number of benefits, including the opportunity to share ideas and work together on important issues. There is considerable value for users in meeting people from other parts of the country. Opportunities for users to share experiences and develop their own self-advocacy and social networks should be encouraged.

Activities of Daily Living↗

PubMed2003

Use of VA health care services by women veterans: findings from a national sample.

The Department of Veterans Affairs (VA) has a Congressional mandate but few empirical data on which to design and improve national health care services for women. We examined characteristics associated with women's current, former and non-use of the VA health care system. The study included 1,500 female veterans sampled from the Department of Veterans Affairs National Registry of Women Veterans. Women completed a 45-minute telephone survey assessing multiple domains of functional status and health service use. Using multivariate logistic regression, use of VA health care was associated with older age, more education, not being married, lower rates of insurance coverage, and poorer physical and psychological health. Women who were former users of VA health care were more likely to be ethnic minorities, have children, served less time in the military, had higher rates of insurance coverage and better physical and psychological health than current users. Prominent military experiences (e.g., service in a war-zone, exposure to trauma) were associated with former use and never using the VA health care system. Women who use VA health care are at greater economic, social, and health risk than nonusers, factors that have personal implications for the veteran as well as cost and service implications for VA. Additional research is needed to better understand the role of military experiences in women veterans' choice of health care.

Adult↗

PubMed2003

The ability of adult mental health services to meet clients' attachment needs: the development and implementation of the Service Attachment Questionnaire.

This study examined the relevance of adult attachment to the relationships between mental health services and their clients. The aim of the study was to develop a self-report measure with acceptable levels of reliability and validity and which was grounded in the experiences of service users, to assess the ability of adult mental health services to meet clients' attachment needs. A combination of qualitative and quantitative methodology was used. The Service Attachment Questionnaire (SAQ) was developed via focus groups of service users, followed by a grounded theory analysis of the group data to identify themes and potential items for inclusion. Two clinical trials were conducted to assess its reliability and validity. The grounded theory analysis produced six key themes forming the basis of the six-subscale, 25-item SAQ. It demonstrated good levels of internal and test-retest reliability. Factor analysis of the subscales revealed a single underlying construct. The SAQ is a reliable and usable self-report measure, and indicates that attachment is relevant to the relationships clients have with mental health services. As the measure is the first of its kind, further exploration of the measure's reliability and validity is recommended.

Clinical Trials as Topic↗