[Experience with intrauterine contraception. Survey of 600 IUD users at the S. Anna University Hospital in Rome].
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Adult↗
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Calming admins and managers--experiences from four years using thin client technology in a hospital environment.
End user desktop computers in a hospital are often full-blown and rich featured PCs. But the distribution of this kind of "computing power" causes big efforts in administration and maintenance and--considering the total cost of owning a PC--is associated with high expenditures of financial and human resources. At the university hospital of Cologne thin client technology is used as an end user desktop device wherever possible. Experiences from four years using this technology are described in this paper.
Cost Savings↗
Using computer vision to help the determination of the gestational age of newborns.
RATIONALE AND OBJECTIVES: This report presents a computational approach to help the gestational age determination of newborns. Gestational age knowledge is fundamental to guide postnatal treatment and increase survival chances of newborns. However, current methods are invasive and do not generate precise results, mainly because they were developed based on nonpremature populations. MATERIALS AND METHODS: We developed an original and noninvasive method to help determination of gestational age based on information supplied by plantar surface images. These images present many details and patterns, but, to date, have not received attention from the image-processing community. We provide a computational tool with suitable facilities to allow the image analysis, either automatically or user driven. This image-processing tool is presented here. RESULTS: The image-processing tool was developed on a user-driven basis. However, as a quantitative experiment, 186 images were processed without user intervention to observe tool behavior in performing different tasks. Although preliminary, experimental results confirm the relationship between plantar surface features and gestational age. CONCLUSION: A prototype of the FootScanAge System is being used and evaluated by experts in neonatology. By means of digital processing of plantar surface images, some characteristics may be shown. Some hypotheses regarding the method have already been confirmed. Also, we show that some well-known image-processing techniques, if appropriately adapted, lead to suitable results when applied to plantar surface images.
Dermatoglyphics↗
From passive subjects to equal partners: qualitative review of user involvement in research.
BACKGROUND: The Department of Health and UK funding bodies have suggested that clinical academics work closely with mental health service users in research projects. Although there are helpful guidelines on the issues that have to be dealt with, there have been few examples of how this partnership research might be undertaken. AIMS: To illustrate the challenges in joint research projects. METHOD: We subjected the process of user involvement to ten questions which arose in the development of a joint research project. The answers are an amalgamation of the user and clinical researcher considerations and are affected by hindsight. RESULTS: The involvement of the user-researcher changed the focus of the study and its design and content. More attention was paid to the intervention itself and the way in which it was delivered. This process increased the amount of time taken to carry out and write up the project as well as incurring financial costs for user consultation payments and dissemination. CONCLUSIONS: This experience has clarified the contribution that users can make, for example by raising new research questions, by ensuring interventions are kept 'user friendly', and the selection of outcome measures.
Biomedical Research↗
iHOPerator: user-scripting a personalized bioinformatics Web, starting with the iHOP website.
BACKGROUND: User-scripts are programs stored in Web browsers that can manipulate the content of websites prior to display in the browser. They provide a novel mechanism by which users can conveniently gain increased control over the content and the display of the information presented to them on the Web. As the Web is the primary medium by which scientists retrieve biological information, any improvements in the mechanisms that govern the utility or accessibility of this information may have profound effects. GreaseMonkey is a Mozilla Firefox extension that facilitates the development and deployment of user-scripts for the Firefox web-browser. We utilize this to enhance the content and the presentation of the iHOP (information Hyperlinked Over Proteins) website. RESULTS: The iHOPerator is a GreaseMonkey user-script that augments the gene-centred pages on iHOP by providing a compact, configurable visualization of the defining information for each gene and by enabling additional data, such as biochemical pathway diagrams, to be collected automatically from third party resources and displayed in the same browsing context. CONCLUSION: This open-source script provides an extension to the iHOP website, demonstrating how user-scripts can personalize and enhance the Web browsing experience in a relevant biological setting. The novel, user-driven controls over the content and the display of Web resources made possible by user-scripts, such as the iHOPerator, herald the beginning of a transition from a resource-centric to a user-centric Web experience. We believe that this transition is a necessary step in the development of Web technology that will eventually result in profound improvements in the way life scientists interact with information.
Computational Biology↗
MUSC information system ARIADNE: a consistent tool for support of experiment planning, execution and scientific evaluation of microgravity-experiments.
One of the main tasks of DLR-MUSC (Microgravity User Support Center) is to accompany an experiment's complete life-cycle, thus supporting the investigators. This task starts with the preparation of experiments, continues with their execution and finally leads to the evaluation of the respective measurement results. A computer-based information system facilitates these tasks. Considerable effort has been taken in order to make a detailed as well as modular design--as a result the system can now be applied for any mission. ARIADNE mainly supports three phases, all using the same consistent database. 1. The first phase of experiment preparation is supported by--the acquisition and maintenance of general and basic data by user entries into the database, and the support of the integration of partially similar experiment proposals into a timeline as planned which is composed by activities. 2. The support during experiment execution consists of--real-time data acquisition and control (i.e. on-line database generation and display after processing) including experiment monitoring, enabling of fast replanning. 3. The support ARIADNE provides for experiment evaluation includes--the selection of series of measurements belonging to the specified experiment (parts), further processing and evaluation of the collected data, which must partly be done in real-time and partly post-mission and, creation of back-up's of the processing results. The ARIADNE database consists of a relational ORACLE-part (for numerical and character data), a bibliographic part, a program-library, and a realtime-part (BAPAS). The open design of ARIADNE allows interfaces to stored special data (such as graphics, images, archives) as well as several interfaces to other systems, such as CUIS, MARS-MDB, EXPRES, etc.
Aerospace Medicine↗
High quality ion channel analysis on a chip with the NPC technology.
In evaluating ion channel function, electrophysiology, e.g., patch clamping, provides the highest information content. For the analysis of ion channel-modulating compounds, one variant of the patch-clamp technique, the whole-cell configuration, is particularly useful. We present here patch-clamp recordings in the whole-cell configuration and single channel recordings performed with planar patch-clamp chips, which are microstructured from borosilicate glass substrate. The chips are used in the Port-a-Patch, an ion channel research/screening instrument that enables automated patch-clamp experiments on a single cell. A software runs the experiment by executing user-determined protocols for cell positioning, as well as for electrical stimulation and current readout. In various electrophysiological experiments, the high quality of recordings and the versatility of the perfusion of the recorded cells are demonstrated. Quantitative pharmacological experiments are performed on sodium channels expressed in HEK cells using solution volumes in the low microliter range. The exceptionally low volume consumption in the experiments make the system attractive for work on rare or expensive compounds. Due to the low volumes necessary, a rapid solution exchange is facilitated, which is shown on RBL cells. The patch-clamp chip enables a rapid and precise perfusion, allowing sophisticated investigations on ion channel function with the Port-a-Patch.
Algorithms↗
Developing a medical informatics education program to support a statewide health information network.
The Florida Health Information Network (FHIN) was established in October 1989 to provide biomedical information services to the University of Florida Health Science Center (HSC) and to health professionals throughout the state--especially the northern thirty-nine counties of the state. FHIN services are available to all affiliates of the HSC and by annual subscription to nonaffiliates. At present, FHIN services include database access, circulation services, document delivery, and information services. Training network users has been an objective since the inception. Training has targeted both the HSC Library staff and HSC users and now is expanding to include remote users. Because many users have had insufficient experience with computers, the library has to teach the mechanics of access and network use and to instruct users regarding applications and database searching. This paper describes the development and implementation of the medical informatics education program. Topics include library staff training; educational offerings for HSC faculty, staff, and students; development and implementation of the remote training program; and organizational and budgetary implications for the construction of such a program.
Computer Communication Networks↗
Levonorgestrel-releasing (20 microgram/day) intrauterine systems (Mirena) compared with other methods of reversible contraceptives.
OBJECTIVE: To assess the relative contraceptive effectiveness, tolerability and acceptability of the levonorgestrel-releasing (20 microg per day) intrauterine system (LNG-20) compared with reversible contraceptive methods in women of reproductive age. DESIGN: A systematic review and meta-analysis of randomised controlled trials. IDENTIFICATION: Studies were identified through seven databases, and by contacting investigators and organisations working in the contraceptive field. MAIN OUTCOME MEASURES: Unplanned pregnancy and continuation of contraceptive method. RESULTS: Five of the seven randomised controlled trials which met the inclusion criteria were included in the meta-analyses; four were comparisons of the LNG-20 intrauterine system with nonhormonal intrauterine devices. LNG-20 intrauterine systems were compared with intrauterine devices divided into two categories, those > 250 mm3 (Copper T 380 Ag and Copper T 380A intrauterine devices) and those < or = 250 mm3 (Nova-T, Copper T 220C and Copper 200 intrauterine devices). Pregnancy rates for the LNG-20 intrauterine system users were significantly less likely to become pregnant compared with users of intrauterine devices < or = 250 mm3, and significantly less likely to have an ectopic pregnancy. LNG-20 intrauterine system users were more likely to experience amenorrhoea and device expulsion than women using intrauterine devices > 250 mm3. LNG-20 intrauterine system users were significantly more likely than all the intrauterine device users to discontinue because of hormonal side effects and amenorrhoea. When the LNG-20 intrauterine system was compared with Norplant-2, the LNG-20 users were significantly more likely to experience oligo-amenorrhoea, but significantly less likely to experience prolonged bleeding and spotting. CONCLUSIONS: The effectiveness of the LNG-20 intrauterine system was similar to or better than other contraceptive methods with which it was compared. Amenorrhoea was the main reason for the discontinuation of the LNG-20 intrauterine system, usually unnecessarily, since this end-organ suppression of bleeding is benign, associated with normal oestrogen levels. Women choosing this method should be informed of potential amenorrhoea when having pre-contraceptive counselling and that absent bleeding may be viewed as a positive outcome.
Contraception↗
An experimental study of strategy development.
Three experiments are reported in which the strategy usage for a compass point directions task was investigated. For this task, people may use either an efficient cancellation strategy or an inefficient spatial strategy (see Roberts, Gilmore, & Wood, 1997). Experiment 1, together with Experiment 2, showed that users of cancellation are unlikely to have explicit prior knowledge of this strategy; instead they discover it as a result of experience with the task. Experiment 1 also showed that strategy selection is unlikely to be based on stylistic preferences, and that reducing the cognitive demands of the task does not increase the discovery of cancellation. Experiment 3 showed that evaluation of strategy validity is also of importance: Unsuccessful evaluation may prevent the selection of a newly discovered strategy, even if it is the more efficient method.
Adult↗
Critical incidents and journey mapping as techniques to evaluate the impact of online evidence retrieval systems on health care delivery and patient outcomes.
BACKGROUND: Online evidence retrieval systems are a potential tool in supporting evidence-based practice. Effective and tested techniques for assessing the impact of these systems on care delivery and patient outcomes are limited. PURPOSE AND METHODS: In this study we applied the critical incident (CI) and journey mapping (JM) techniques to assess the integration of an online evidence system into everyday clinical practice and its impact on decision making and patient care. To elicit incidents semi-structured interviews were conducted with 29 clinicians (13 hospital physician specialists, 16 clinical nurse consultants (CNCs)) who were experienced users of the online evidence system. Clinicians were also asked questions about how they had first used the system and how their use and experiences had changed over time. These narrative accounts were then mapped and scored using the journey mapping technique. RESULTS: Clinicians generated 85 critical incidents. Three categories of impact were identified: impact on clinical practice, impact on individual clinicians and impact on colleagues through the dissemination of information gained from the online evidence system. One quarter of these included specific examples of system use leading to improvements in patient care. Clinicians obtained an average journey mapping score of 22 out of a possible score of 36, demonstrating a good level of system integration. Average scores of doctors and CNCs were similar. However individuals with the same scores often had very different journeys in system integration. CONCLUSIONS: The CI technique provided clear examples of the way in which system use had influenced practice and care delivery. The JM technique was found to be a useful method for providing a quantification of the different ways and extent to which, clinicians had integrated system use into practice, and insights into how system use can influence organisational culture. The development of the journey mapping stages provides a structure by which the program logic of a clinical information system and its desired outcomes can be made explicit and be based upon users' experiences in everyday practice. Further work is required using this technique to assess its value as an evaluation method.
Clinical Competence↗
Analysis and management of HIV peptide microarray experiments.
OBJECTIVES: To develop a tool for then easy and user-friendly management of peptide microarray experiments and for the use of the results of these experiments for the study the immune response against HIV virus infection in clinical samples. METHODS: Applying bioinformatics and statistics for the analysis of data coming from microarray experiments as well as implementing a MIAME (Minimum Information About a Microarray Experiment) compliant database for managing and annotating experiments, results and samples. RESULTS: We present a new tool for managing not only nucleic acid microarray experiments but also protein microarray experiments. From the analysis of experimental data, we can detect different profiles in the reactivity of the sera with different genotypes. CONCLUSIONS: We have developed a new tool for managing microarray data including clinical annotations for the samples as well as the capability of annotating other microarray formats different to those based on nucleic acids. The use of peptide microarrays and bioinformatics analysis opens a new scope for the characterization of the immune response, and analyzing and identifying the humoral response of viruses with different genotypes.
Computational Biology↗
Predictors and consequences of negative physician attitudes toward HIV-infected injection drug users.
BACKGROUND: We evaluated physicians' training, experience, and practice characteristics and examined associations between their attitudes toward human immunodeficiency virus (HIV)-infected persons who are injection drug users (IDUs) and quality of care. METHODS: Cross-sectional surveys were conducted among a probability sample of noninstitutionalized HIV-infected individuals in the United States and their main HIV care physicians. Physician and practice characteristics, training, HIV knowledge, experience, attitudes toward HIV-infected IDUs, stress levels, and satisfaction with practice were assessed. The main quality-of-care measures were patient exposure to highly active antiretroviral therapy, reported problems, satisfaction with care, unmet needs, and perceived access to care. RESULTS: Nationally, 23.2% of HIV-infected patients had physicians with negative attitudes toward IDUs. Seeing more IDUs, having higher HIV treatment knowledge scores, and treating fewer patients per week were independently associated with more positive attitudes toward IDUs. Injection drug users who were cared for by physicians with negative attitudes had a significantly lower adjusted rate of exposure to highly active antiretroviral therapy by December 1996 (13.5%) than non-IDUs who were cared for by such physicians (36.1%) or IDUs who were cared for by physicians with positive attitudes (32.3%). Physician attitudes were not associated with other problems with care, satisfaction with care, unmet needs, or perceived access to care. CONCLUSIONS: Negative attitudes may lead to less than optimal care for IDUs and other marginalized populations. Providing education or experience-based exercises or ensuring that clinicians have adequate time to deal with complex problems might result in better attitudes and higher quality of care.
Adult↗
BarleyBase--an expression profiling database for plant genomics.
BarleyBase (BB) (www.barleybase.org) is an online database for plant microarrays with integrated tools for data visualization and statistical analysis. BB houses raw and normalized expression data from the two publicly available Affymetrix genome arrays, Barley1 and Arabidopsis ATH1 with plans to include the new Affymetrix 61K wheat, maize, soybean and rice arrays, as they become available. BB contains a broad set of query and display options at all data levels, ranging from experiments to individual hybridizations to probe sets down to individual probes. Users can perform cross-experiment queries on probe sets based on observed expression profiles and/or based on known biological information. Probe set queries are integrated with visualization and analysis tools such as the R statistical toolbox, data filters and a large variety of plot types. Controlled vocabularies for gene and plant ontologies, as well as interconnecting links to physical or genetic map and other genomic data in PlantGDB, Gramene and GrainGenes, allow users to perform EST alignments and gene function prediction using Barley1 exemplar sequences, thus, enhancing cross-species comparison.
Arabidopsis↗
The use of qualitative methods in the study of parents' experiences of care on a children's surgical ward.
User satisfaction with the care of hospitalized children is examined in this paper. It is argued that parents are proxy consumers but that their status is conditional on the way in which they exercise choices. Parents' involvement in the care of their children means that the term 'user' is more appropriate than 'consumer'. Methodological problems in the assessment of user satisfaction are discussed. A study of the experiences of parents of 24 children discharged from a surgical ward of a children's hospital is described and the implications for the assessment of user satisfaction reviewed. The study demonstrates that qualitative methods have value in the assessment of user satisfaction with care. A particular strength of qualitative methods of inquiry is that limitations of users' choice in care can be assessed.
Child↗
Documenting resident procedure and diagnostic experience: simplifying the process.
BACKGROUND AND OBJECTIVES: The Residency Review Committee (RRC) requires documentation of family practice residents' procedural and diagnostic experiences. Further, hospital privileging is frequently based on documentation of prior clinical experience. Residency programs need a user-friendly (ie, resident-friendly) mechanism for collecting data and generating reports to document these experiences. This paper outlines a simplified, user-friendly method of documenting resident procedural and diagnostic experiences. METHODS: We developed a pocket-sized, optically scannable card for data input. This is coupled with a computerized database with report generation capability. The system is based on diagnostic clusters to further simplify the data input process. RESULTS: The system's setup costs are about $10,000. Annual maintenance and operational fees are about $5,000. After instituting the system, the number of residents submitting documentation information increased substantially. CONCLUSIONS: This system meets both RRC and potential clinical privileging requirements and provides a useful tool for guiding resident evaluation and developing appropriate training opportunities during the latter half of the residency. Simplified, accurate documentation may allow for comparisons among residents at various levels--program, state, and national.
Clinical Competence↗
The role of the sound of tapping for nonvisual judgment of gap crossability.
The author investigated the possibility that nonvisual locomotion with a cane depends on the sound of the cane tapping. Blindfolded participants were asked to judge whether a gap in front of them could be crossed by walking. An acoustic analysis suggested that sound could, in theory, distinguish the gaps. Blindfolded sighted participants in Experiments 1 and 2 judged crossability under conditions in which only the sound of tapping was available and in which the sound was minimized; the third and fourth experiments included experienced cane users. Both inexperienced observers and experienced cane users were unaffected by sound reduction and were less able to discriminate gaps when using sound only than when using reduced sound. A fifth experiment indicated that active-passive differences were not responsible for these effects. Results indicate that sound is not necessary or sufficient for judging nonvisible crossability with a probe.
Auditory Perception↗
FEASIBLE (I): The PC software package for feature evaluation and system inspection by logged experiments.
FEASIBLE is an MS-DOS software package which can be used for the evaluation of: Picture Archiving and Communication System (PACS) components; diagnostic image quality; and image manipulation and representation techniques. The FEASIBLE software allows the user to design any psychophysical study in detail in the fields mentioned above, to execute an arbitrary number of sessions and to statistically analyse the results by way of the Receiver Operating Characteristic (ROC) technique. FEASIBLE consists basically of three modules: DESIGN, which allows the user to set up an experiment; EXECUTION, which allows the user to execute the experimental sessions based on the design entered in the DESIGN module and stored in the program's database; and, STATISTICS, which allows various statistical analyses on the data collected during the psychophysical sessions (including the calculation of ROC curves and related parameters) and can provide a graphical presentation of the results. FEASIBLE has been designed to support experts and those who have little knowledge of psychophysical experiments. This paper discusses the background, structure and possibilities of the FEASIBLE package at this point (version 1.2, May 1988).
Hospital Information Systems↗