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PubMed2004

Creation and development of an All-Wales Health Library Catalogue.

This article focuses on the collaboration between the University of Wales College of Medicine (UWCM) libraries and the Welsh National Health Service (NHS) libraries to create a joint library catalogue. The goal was to create an all-Wales resource that gave users one access point to search for the location and availability of health-related material in any Welsh medical library. This venture grew out of the existing collaborative scheme, the All-Wales Health Information and Library Extension Services (AWHILES). Currently, all seven UWCM libraries and 17 NHS libraries contribute to the catalogue. Four more libraries are due to join in late 2003 or early 2004. All UWCM and AWHILES libraries would then be contributing members of the joint catalogue. The article discusses the background and motivation to the creation of the database. It explores the positives and negatives of the project plus what was learnt as the venture progressed. It reviews the establishment and operations of the Welsh Health Voyager User Group (WHVUG) created to involve all contributing members in the running and future development of the library catalogue.

Catalogs, Library↗

PubMed2006

Perspectives on health among adult users of illicit stimulant drugs in rural Ohio.

CONTEXT: Although the nonmedical use of stimulant drugs such as cocaine and methamphetamine is increasingly common in many rural areas of the United States, little is known about the health beliefs of people who use these drugs. PURPOSE: This research describes illicit stimulant drug users' views on health and health-related concepts that may affect their utilization of health care services. METHODS: A respondent-driven sampling plan was used to recruit 249 not-in-treatment, nonmedical stimulant drug users who were residing in 3 rural counties in west central Ohio. A structured questionnaire administered by trained interviewers was used to collect information on a range of topics, including current drug use, self-reported health status, perceived need for substance abuse treatment, and beliefs about health and health services. FINDINGS: Participants reported using a wide variety of drugs nonmedically, some by injection. Alcohol and marijuana were the most commonly used drugs in the 30 days prior to the interview. Powder cocaine was used by 72.3% of the sample, crack by 68.3%, and methamphetamine by 29.7%. Fair or poor health status was reported by 41.3% of the participants. Only 20.9% of the sample felt they needed drug abuse treatment. Less than one third of the sample reported that they would feel comfortable talking to a physician about their drug use, and 65.1% said they preferred taking care of their problems without getting professional help. CONCLUSIONS: Stimulant drug users in rural Ohio are involved with a range of substances and hold health beliefs that may impede health services utilization.

Adult↗

PubMed2004

Mistaken identifiers: gene name errors can be introduced inadvertently when using Excel in bioinformatics.

BACKGROUND: When processing microarray data sets, we recently noticed that some gene names were being changed inadvertently to non-gene names. RESULTS: A little detective work traced the problem to default date format conversions and floating-point format conversions in the very useful Excel program package. The date conversions affect at least 30 gene names; the floating-point conversions affect at least 2,000 if Riken identifiers are included. These conversions are irreversible; the original gene names cannot be recovered. CONCLUSIONS: Users of Excel for analyses involving gene names should be aware of this problem, which can cause genes, including medically important ones, to be lost from view and which has contaminated even carefully curated public databases. We provide work-arounds and scripts for circumventing the problem.

Animals↗

PubMed2005

The effects of creating psychological ownership on physicians' acceptance of clinical information systems.

OBJECTIVE: Motivated by the need to push further our understanding of physicians' acceptance of clinical information systems, we propose a relatively new construct, namely, psychological ownership. We situated the construct within a nomological net using a prevailing and dominant information technology adoption behavior model as a logical starting point. DESIGN: A mail survey was sent to the population of users of a regional physician order entry (POE) system aimed at speeding up the transmission of clinical data, mainly laboratory tests and radiology examinations, within a community health network. MEASUREMENTS: All scales, but one, were measured using previously validated instruments. For its part, the psychological ownership scale was developed using a multistage iterative procedure. RESULTS: Ninety-one questionnaires were returned to the researchers, for a response rate of 72.8%. Our findings reveal that, in order to foster physicians' adoption of a clinical information system, it is important to encourage and cultivate a positive attitude toward using the new system. In this connection, positive perception of the technology's usefulness is crucial. Second, results demonstrate that psychological ownership of a POE system is positively associated with physicians' perceptions of system utility and system user friendliness. Last, through their active involvement and participation, physicians feel they have greater influence on the development process, thereby developing feelings of ownership toward the clinical system. CONCLUSION: Psychological ownership's highly significant associations with user participation and crucial beliefs driving technology acceptance behaviors among physicians affirm the value of this construct in extending our understanding of POE adoption.

Attitude of Health Personnel↗

PubMed2001

An attributable cost model for a telecare system using advanced community alarms.

We have developed an attributable cost model for a city-based telecare scheme involving 11,618 community alarm users. The equipment was assumed to cost 500 Pounds-1000 Pounds per installation, compared with 175 Pounds for the current system. Because of the significant additional capital cost of the proposed system, it would be necessary to borrow to finance it. For example, if the home equipment cost 500 Pounds per unit, an additional 2.2 million Pounds would be required. Nonetheless, it would be possible to achieve a return on the investment after 10 years. The principal savings would arise from reduced hospital bed costs and reduced residential care. The model suggests that the financial benefits of the proposed system would occur in the ratio of 4% to the local authority housing department, 43% to the National Health Service and 53% to the residential care provider.

Aged↗

PubMed2005

Quality, value, accountability and information as transforming strategies for patient-centred care: a commentary from an international perspective.

The reviewed paper describes how one of the largest integrated healthcare systems in the US has successfully transformed itself to provide 21st-century healthcare. Even though there are other examples of successful transformation of public health services, it is difficult for large, bureaucratic systems to change, and a substantial number of ministries of health or social security health systems in the developing world are run under the assumption that change is very difficult if not impossible to achieve. The VA has significant differences and more financial resources compared to most of the developing world public health institutions; but still, change is often not only about money, but also about strategic direction, commitment and leadership. On the basis of the main strategies used by the VA in its transformation process, the author makes some comments and suggestions for improving developing world healthcare organizations through lessons learned from the VA management strategies. Demand-driven or patient-centred systems are key for success and for the buy-in and involvement of the population and users of healthcare services, but this is easier said than done, especially in developing healthcare systems with immature information systems, access mechanisms and knowledge management. There is a belief in general that large bureaucratic organizations have a hard time adapting and transforming in response to the rapid change of society, technology and most importantly the needs and expectations of their users. The article describes how the largest integrated healthcare organization in the United States, the Veterans Health Administration, has undertaken changes that have turned it into a modern, well-managed organization that outperforms its competitors and has significantly increased its efficiency and users' satisfaction.

Delivery of Health Care, Integrated↗

PubMed2005

Creating options in family planning for the private sector in Latin America.

The countries of Latin America and the Caribbean are facing the gradual phase-out of international-donor support of contraceptive commodities and technical and management assistance, as well as an increased reliance on limited public sector resources and a limited private sector role in providing contraceptives to the public. Therefore, those nations must develop multisectoral strategies to achieve contraceptive security. The countries need to consider information about the market for family planning commodities and services in order to define and promote complementary roles for the public sector, the commercial sector, and the nongovernmental-organization sector, as well as to better identify which segments of the population each of those sectors should serve. While it is unable to mandate private sector participation, the public sector can create conditions that support and promote a greater role for the private sector in meeting the growing needs of family planning users. Taking steps to actively involve and expand the private sector's market share is a critical strategy for achieving a more equitable distribution of available resources, addressing unmet need, and creating a more sustainable future for family planning commodities and services. This paper also discusses in detail the experiences of two countries, Paraguay and Peru. Paraguay's family planning market illustrates a vibrant private sector, but with limited access to family planning commodities and services for those who cannot afford private sector prices. In Peru a 1995 policy change that sought to increase family planning coverage had the effect of restricting access for the poor and leaving the Ministry of Health unable to pay for the growing need for family planning commodities and services.

Adult↗

PubMed1997

NSAIDs and increased blood pressure. What is the clinical significance?

Several randomised studies have demonstrated that various nonsteroidal anti-inflammatory drugs (NSAIDs) elevate blood pressure in normotensive and hypertensive individuals; however, these data have been contradicted by numerous negative studies. Two meta-analyses have demonstrated that, after pooling data drawn from published reports of randomised trials of younger adults, NSAID use produces a clinically significant increment in mean blood pressure of 5 mm Hg, most marked in patients with controlled hypertension. Stratification by NSAID type revealed that piroxicam, naproxen and indomethacin had the greatest, and sulindac the smallest, pressor effect. These data were supported by 2 large community studies involving elderly patients. Recent NSAID users had a 1.7-fold higher risk of requiring the initiation of antihypertensive therapy compared with nonusers; NSAID users also had a 40% increased risk of receiving a diagnosis of hypertension compared with nonusers. It is vital to determine the nature of the association in the elderly, 12 to 15% of whom are concurrently receiving an NSAID and an antihypertensive agent. Importantly, a 5 to 6 mm Hg increase in diastolic blood pressure maintained over a few years may be associated with a 67% increase in total stroke risk and a 15% increase in coronary heart disease events. While the mechanism(s) remain speculative, salt and water retention through several factors operating in parallel, coupled with increased total peripheral vascular resistance, via increased renal endothelin-1 synthesis, are potentially important. Clinicians should strive to avoid excessive use of NSAID treatment and consider well-tolerated therapeutic alternatives, including simple analgesics and physical therapy. For patients who require concomitant NSAID and antihypertensive treatment, physicians should be aware that indomethacin, naproxen and piroxicam may be associated with a greater pressor effect than many other NSAIDs, and that antagonism of beta-blockers may be greater than that of vasodilators (including ACE inhibitors and calcium antagonists) and diuretics. Finally, the progress of each patient should be monitored by careful blood pressure measurement, particularly during the period of initiation of NSAID therapy.

Adult↗

PubMed1983

Women, health and the sexual division of labor: a case study of the women's health movement in Britain.

The women's health movement in Britain can be divided into three main stages. During the first period, most activities took place outside the National Health Service (NHS) and the emphasis was on women as consumers of medical care. Feminists exposed the sexism inherent in most medical practice and stressed the need for women to gain control of reproductive technology. During the second phase, these priorities shifted toward a greater concern with the need to defend the NHS against reductions in resources and to oppose the increasing privatization of medical care. These campaigns involved women not only as users of medical services but also as health workers, thereby bringing the women's health movement into the wider political arena. They also led to the growth of a socialist feminist analysis of women's health issues and a recognition that feminist participation in health struggles is essential if the NHS is to be not merely defended but qualitatively changed to meet the real needs of consumers and workers. During the third (and current) stage of the women's health movement, feminists have moved beyond a concern with medical care alone toward the development of a socialist feminist epidemiology--toward the identification and eventual elimination of those aspects of contemporary society that make women sick.

Consumer Organizations↗

PubMed1999

An exploratory study of recreational drug use and nutrition-related behaviors and attitudes among adolescents.

This study examined drug use and eating behaviors among adolescents. The data were collected by phone interviews from 401 northern Nevadan students in grades seven to twelve. Students were divided for comparison into three groups according to their involvement with drugs: Abstainers, conventional users, and high-risk users. Analyses indicated that high-risk users less frequently ate lunch, meals at home, and with their families, and ate more often at convenience stores, fast food restaurants, and with friends. In addition, female high-risk users had significantly more negative perceptions regarding their food choices than the other female groups, and were more concerned with dieting than their high-risk using male peers. Male and female high-risk users believed that their drug use affected their eating habits. Implications for prevention programming and future research are discussed.

Adolescent↗

PubMedDate not supplied

A user-oriented validation method for clinical data.

The patient data in hospitals is prone to many errors during computerization because of the large human element involved during the processes concerned. A user-oriented validation method, which has been found to be practical and acceptable, is suggested. A non-statistical approach is adopted in this regard. The qualitative requirements of all users for validation have been taken as the guidelines to achieve maximum user acceptability. A user-oriented data code sheet, whose format changes for different disease groups, has been devised to prevent most of the typographical errors. These code sheets have also been found to be of considerable help to doctors in keeping a check on any missed or incomplete investigations, examinations and history recording. The validation program detects all errors of a typographical nature and all commonly possible logical errors. In addition, the program outputs data values, whose accuracy is doubtful, in the form of warning messages like WARNED DATA and ERRONEOUS DATA. The data fields which do not contain any data are also output to help the clinicians to take note of investigations and clinical tests not done or whose results are awaited. The logical errors, if any, also help them in detecting and identifying atypical cases in any given disease group at the earliest possible stage of a patient's hospitalization. In this paper, the need for a user-oriented and non-statistical approach to the validation of clinical data has been discussed in detail and its advantages enumerated.

Electronic Data Processing↗

PubMedDate not supplied

TNM staging of cancers of the head and neck: striving for uniformity among diversity.

The sixth edition of the tumor-node-metastasis staging system for head and neck cancers incorporates some significant shifts in philosophy. As treatment paradigms shift and data from ongoing clinical and basic research become available, further revisions may be expected in the future. The purpose of this review is to highlight the complexities involved in developing a user-friendly staging system and to report the major changes in the new version. The authors also discuss some areas of current interest that may have the potential to lead to future modifications.

Head and Neck Neoplasms↗

PubMed2006

Joint inspection of services for people with learning disabilities in Scotland: compliance or commitment?

PURPOSE: The article describes the development of a practical model of joint, integrated inspection of managed care services for people with learning disabilities in Scotland. The model will give a reliable measure of the impact services are making to people's lives and the quality of service that individuals are actually receiving. CONTEXT OF CASE: At present health, social services and education services for people with learning disabilities in Scotland are inspected separately, by up to nine different agencies. The first joint, integrated inspections of all services for people with learning disabilities in Scotland will take place in 2006. This is the first inspection of its kind in the UK, and the first to involve carers and people with learning disabilities on the inspection team. DATA SOURCES: Quality Outcome Indicators were developed in 21 different areas, or domains. Evidence based best practice, and evaluative data from previous inspections were the primary sources of data. CASE DESCRIPTION: This paper reviews the background and rationale for the integrated, joint inspection process. Strengths and constraints of this approach to inspection are discussed, including the crucial importance of commitment from services and from inspectors, rather than mere compliance with demands. Some guidance on how to fully involve staff, carers and services users in the inspection process is given. CONCLUSIONS AND DISCUSSION: The model will produce data to inform decision-making for managers in integrated services and give services users clear information about how well local needs are being met, what areas need development, and what capacity the organisations have to improve. The model of inspection may be of interest to practitioners in a national and international context. The model will be evaluated, following the first joint inspection.

Journal Article↗

PubMed1998

Evidence-based medicine: a means of improving clinical outcome and cost-benefit ration.

Evidence-based medicine (EBM) is a new way of conceiving clinical practice based on the need to both improve the approach to the patient's care and rationalize the costs. EBM is thus defined as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients". To realize this project a cultural change is mandatory, involving doctors, health planners, and users, whose empowerment seems pivotal. Reasoning in terms of efficacy or even better of cost-benefit ratio will certainly improve the clinical outcome and the allocation of resources.

Cost-Benefit Analysis↗

PubMed1994

Read my lips--no more late deliveries.

Over 70,000 materiel requirements planning (MRP) and manufacturing resource planning (MRP II) systems have been implemented in this country in the last 20 to 30 years. Yet the question many of the companies who own these systems are asking is, "Was it worth it?" Less than a third of the companies are answering in the affirmative. Two key differences between the satisfied and the not-so-satisfied companies are (1) support to the user community and (2) management involvement in the day-to-day use of the system. Without these two items, the improvements brought about by an MRP or MRP II system will most likely be mediocre at best.

Consumer Behavior↗

PubMed1988

Evaluating health care facilities.

Much lip service is given to the idea of post-occupancy evaluation by planners and architects, but examples are rare. The firm these authors represent has had a formal and documented post-occupancy evaluation (POE) program in place since the mid-1960s. In this article, the authors offer a model POE process involving the project team and users working together at the project site. Subjective and objective data are combined in a quantitative scoring format, and lessons learned are documented for use by both the institution (operationally) and the planner/designer team (in future projects). The POE model is demonstrated by application to a project recently completed for the University of Washington Hospitals and Clinics in Seattle.

Evaluation Studies as Topic↗

PubMed2000

Cocaine and methamphetamine: differential addiction rates.

Clients admitted to treatment centers for stimulant addiction were categorized as either regular users of cocaine or of methamphetamine based on an algorithm involving 5 specific criteria. A subsample consisting of 90 regular users of cocaine and nonusers of methamphetamine, and 39 regular users of methamphetamine and nonusers of cocaine, was selected for comparison. Analyses showed that, when compared with cocaine users, the methamphetamine users exhibited a shorter period of time from 1st use to regular use (period of initial use) and from 1st use to treatment entry (period of pretreatment use). Relative to cocaine use, the use of methamphetamine appears to induce a faster rate of progression toward regular use and subsequent need for treatment.

Adult↗

PubMed2001

Changes in health-promoting behavior following diagnosis with HIV: prevalence and correlates in a national probability sample.

Diet, exercise, smoking, and substance use patterns affect the course of illness and quality of life for people with HIV. In interviews with a national probability sample of 2,864 persons receiving HIV care, it was found that most had made health-promoting changes in one or more of these behaviors since diagnosis. Many reported increased physical activity (43%) and improved diet (59%). Forty-nine percent of cigarette smokers quit or cut down; 80% of substance users did so. Desire for involvement in one's HIV care and information seeking-positive coping were the most consistent correlates of change. Other correlates varied by health practice but included health status, emotional well-being, demographics, and attitudes toward other aspects of HIV care. Most people with HIV improve their health behavior following diagnosis, but more might be helped to do so by targeting these behaviors in future interventions.

Adaptation, Psychological↗