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PubMed2000

[National sentinel surveillance of HIV infection in China from 1995 to 1998].

OBJECTIVE: To monitor the trend of HIV infection in China in order to provide accurate information for AIDS prevention policymakers and planners. METHODS: Since 1995, cross - sectional sentinel surveys have repeatedly been conducted in China. The target populations in these surveys were STD clinic attenders, prostitutes, drug users, long distance truck drivers, pregnant women, and blood donors. RESULTS: In 1995, survey results found no HIV infection among drug users in 8 sentinel surveillance sites. In 1998 however, HIV infection had been found in 17 of 19 sentinel surveillance sites. HIV infection prevalence rates among drug users in Urumqi had increased from 0% in 1995 to 28.8% in 1998 and in Guangxi and Guangdong, from 1% in 1997 to 12.8% and 10.4% respectively. The highest HIV prevalence rate was 82.2% among drug users in Yining city. The HIV prevalence rate remains low in other risk groups but has increased among prostitutes, whose rate of insistent condom use remains low, and among STD clinic attenders. Needle and syringe sharing among drug users have also increased in many sites. CONCLUSION: HIV infection is spreading rapidly among drug users. There are many risks involved in the spread of HIV among prostitutes and their clients, and thus more efficient interventions are urgently needed.

Adult↗

PubMed2001

About the impossibility of a single (ex-)user and survivor of psychiatry position.

OBJECTIVE: To present the European Network of (ex-)users and survivors of psychiatry and discuss issues of concern among (ex-)users and survivors. METHOD: Material from papers and documents published by and discussed among (ex-)users and survivors of psychiatry is used to outline topics of interest. RESULTS: The European Network of (ex-)Users and Survivors of Psychiatry (ENUSP) was founded in 1991 as an association of national/regional organizations of (ex-)users and survivors of psychiatry. The network organizes biennial conferences, all delegates are (ex-)users and survivors of psychiatry. ENUSP aims include the fight against discrimination of people with experience of the psychiatric system, support for (ex-)user/ survivor organizations, influence on policy-making, legislation and human rights debates, demedicalizing psychiatry, and opposition to unidimensional approaches to mental and emotional distress. CONCLUSION: (Ex-)users and survivors should be involved in monitoring psychiatric services, education and examination of mental health professionals. User/survivor-controlled services constitute an important innovative service.

Europe↗

PubMed2003

[Guideline development in the Academic Medical Center, Amsterdam, the Netherlands, 1992-2001].

OBJECTIVE: To evaluate a program for the local development and implementation of evidence based guidelines in the Academic Medical Center in Amsterdam, the Netherlands. DESIGN: Retrospective evaluation study. METHOD: In the period 1992-2001, 50 guideline projects had received funding. Two questionnaires were developed to monitor aspects of development and implementation of guidelines. The first questionnaire was based on the 'Appraisal of Guidelines for Research & Evaluation' (AGREE) instrument. In total 39 projects of which the original application form as well as the final report was accessible, were scored by 3 researchers. A second questionnaire was developed on the basis of an implementation model by Grol and was filled out by 46 applicants. RESULTS: The primary motive for the development of a guideline were doubts about the effectiveness of a procedure. In 79% researchers (partly) collected their own data. The future users of the guideline were involved in an early stage of the development project in 72% of all cases. In 28% potential obstructing factors were identified. Introduction of the guideline was done through oral presentations in 42% without the use of an extensive implementation strategy. Of all subsidized projects, 24% was ongoing and 74% had been implemented successfully. CONCLUSION: In the AMC-program subsidized projects often led to successfully developed guidelines, which subsequently were introduced in practice.

Evidence-Based Medicine↗

PubMed1992

PEN&PAD (Geriatrics): a Collaborative Patient Record System for the shared care of the elderly.

The PEN&PAD (Geriatrics) project seeks to develop a Collaborative Patient Record System for the hospital based shared care of the elderly. The goal of the project is to produce a single, integrated information system which is both useful and usable by the different practitioner groups involved in geriatric care. A User Centred Design methodology is proposed which makes users and human issues central to the design and development process. Preliminary results indicate that the specification of a Minimum Basic Data Set as the basis of a shared record system is infeasible and undesirable. An architecture is presented which illustrates how the diversity between the different disciplines may be preserved in a Collaborative Patient Record System.

Geriatrics↗

PubMed2005

Mental health. Barrier grief.

There is a belief in the mental health sector that poor commissioning is slowing modernisation. A problem has been identified in the balance of power, with large trusts providing services for several PCTs. The difficulty in measuring outcomes is key. Strong commissioning needs the involvement of carers and service users.

Attitude of Health Personnel↗

PubMed2004

Quality and reliability of data collected in a regional hospital intensive care unit.

OBJECTIVE: To examine the accuracy of the existing data collection system in an intensive care unit (ICU). METHODS: Prospective audit of data collection for APACHE II in a six-bedded general ICU in a region-al hospital for consecutive ICU admissions over a 12 month period. The existing resident medical officer (RMO) data collection system continued unaltered while concurrent collection of APACHE II data completed by one senior medical officer (SMO) was also performed. RMO-APACHE scores were compared to SMO-APACHE scores. RESULTS: The median (interquartile range) APACHE II scores were: 15 (9-21) for RMO data; 17 (12 - 22) for SMO data (p = 0.0001), with a mean difference (SD) of 4.2 (4.2) (p < 0.0001). A rapid survey of New Zealand ICU's indicated that only 4 of 11 APACHE II users employed substantial medical specialist involvement in APACHE II data collection and/or scrutiny prior to database entry. CONCLUSIONS: The existing APACHE II data collection is often imperfect and requires further attention as it is not yet reliable enough to allow for accurate SMR calculations, or for external use for comparative purposes.

Journal Article↗

PubMed1980

Drug consumption among the student population of Mexico City and its metropolitan area: subgroups affected and distribution of users.

The results of a survey based on a sample of 4,059 students attending intermediate and upper intermediate schools in Mexico City and its metropolitan area showed that the percentage of drug use "ever" by substance was the following: alcohol, 59; tobacco, 53.2; inhalants, 5.4; cannabis, 3.8; tranquilizers, 3.1; amphetamines, 2.7; sedatives, 1.3; opium, 0.91; LSD, 0.54; cocaine, 0.52; heroin, 0.29. Of the students reporting use "ever", the percentage reporting use of one of these substances "in the past months" ranged from 22.5 to 58.3. While there were more female students among the users of tranquilizers and stimulants, male students predominated among the users of other substances, with the difference being most pronounced among cannabis users. Older students were more involved with cannabis; in contrast, inhalants were more popular with younger students. The use of other substances varied little with age. Use of alcohol and cannabis was also most frequent among students of schools in middle, upper middle and upper class areas, whereas use of inhalants was most common among students attending schools in lower class areas.

Adolescent↗

PubMed1981

Preselecting literature for routine delivery to physicians in a community hospital-based patient care related reading program.

Health sciences librarians have been actively responding to the changing information needs of users by extending services which involve the selection of literature in response to specific requests from health care personnel. A further development is Patient Care Related Reading (PCRR), a hospital-based program of continuing medical education in which the librarian actively participates in the preselection, packaging, and routine delivery of literature for use by physicians caring for patients with certain clinical disorders. Criteria for selection of literature packet topics were developed jointly by librarians and physicians at their own hospitals. Librarians compiled bibliographic material, reviewed articles, and prepared preliminary packets. Physicians reviewed these packets and made suggestions for each article. Librarians then prepared final packets following reviewers' recommendations and distributed them as a routine procedure to all physicians caring for patients with a diagnosis corresponding to prepared topics. Librarians were notified of patients with PCRR clinical problems by admitting office personnel, floor nurses, nursing supervisors, utilization review, and Professional Standards Review Organization personnel as a part of their usual activities. Packets are used by physicians to add to their fund of knowledge, and for review and teaching purposes. PCRR has provided increased visibility of the library and its many services. Recognition of the librarian's role in the program reinforces the concept of the community hospital library as a service-oriented entity, and helps to establish the library as an active partner in the development and implementation of hospital-based continuing education programs.

Hospitals, Community↗

PubMed1994

Injected-drug use: complications and costs in the care of hospitalized HIV-infected patients.

The aim of this study was to determine the contribution of injected-drug-use complications to the utilization of inpatient care by persons infected with human immunodeficiency virus (HIV). Retrospective chart review was done of all hospital admissions between January 1, 1991, and December 31, 1991, with outpatient records reviewed to establish CD4 counts within 3 months of the date of admission. The participants included 284 consecutive admissions (189 patients); admissions were divided into two groups according to the Center for Disease Control 1993 expanded AIDS definition: those with AIDS (CD4 count, < 200 cells/microliters) and those with early HIV disease (CD4 count, > 200 cells/microliters). Thirty percent of admissions occurred among persons with early HIV disease. Among 189 individuals admitted to the hospital, 84% were male, 62% were white, and 48% had injected drugs. Early HIV disease admissions were more likely to involve active injection-drug users (82% vs. 33%; p < 0.01). Admissions related to injected-drug use constituted 60% of early HIV disease hospitalizations, and this number rises to 72% if bacterial pneumonia is included as a substance abuse complication. Admissions related to injected-drug use constituted 27% of AIDS admissions; this number rises to 51% if bacterial pneumonia is included. Early HIV disease admissions were significantly shorter (9.9 vs. 12.6 days) and less expensive (mean charge, $9,592 vs. 12,873) than AIDS admissions but still accounted for 25% of inpatient HIV charges. Hospitalizations among HIV-infected persons early in the course of HIV disease are most often related to the medical complications of injected-drug use and account for a substantial expenditure of hospital resources.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Image analysis in cytology: DNA-histogramming versus cervical smear prescreening.

The visual inspection of cellular specimens and histological sections through a light microscope plays an important role in clinical medicine and biomedical research. The human visual system is very good at the recognition of various patterns but less efficient at quantitative assessment of these patterns. Some samples are prepared in great numbers, most notably the screening for cervical cancer, the so-called PAP-smears, which results in hundreds of millions of samples each year, creating a tedious mass inspection task. Numerous attempts have been made over the last 40 years to create systems that solve these two tasks, the quantitative supplement to the human visual system and the automation of mass screening. The most difficult task, the total automation, has received the greatest attention with many large scale projects over the decades. In spite of all these efforts, still no generally accepted automated prescreening device exists on the market. The main reason for this failure is the great pattern recognition capabilities needed to distinguish between cancer cells and all other kinds of objects found in the specimens: cellular clusters, debris, degenerate cells, etc. Improved algorithms, the ever-increasing processing power of computers and progress in biochemical specimen preparation techniques make it likely that eventually useful automated prescreening systems will become available. Meanwhile, much less effort has been put into the development of interactive cell image analysis systems. Still, some such systems have been developed and put into use at thousands of laboratories worldwide. In these the human pattern recognition capability is used to select the fields and objects that are to be analysed while the computational power of the computer is used for the quantitative analysis of cellular DNA content or other relevant markers. Numerous studies have shown that the quantitative information about the distribution of cellular DNA content is of prognostic significance in many types of cancer. Several laboratories are therefore putting these techniques into routine clinical use. The more advanced systems can also study many other markers and cellular features, some known to be of clinical interest, others useful in research. The advances in computer technology are making these systems more generally available through decreasing cost, increasing computational power and improved user interfaces. We have been involved in research and development of both automated and interactive cell analysis systems during the last 20 years. Here some experiences and conclusions from this work will be presented as well as some predictions about what can be expected in the near future.

Cervix Uteri↗

PubMed1997

The validity of self-reported drug use in survey research: an overview and critique of research methods.

Since illicit drug use is by definition illegal, the tasks of measuring incidence and prevalence and charting the course of the epidemic have fallen to survey researchers over the past 30 years. Although survey methods have obvious advantages over indirect measures such as arrests, seizures, and treatment admissions, they are frequently criticized because the rely on valid self-reporting of sensitive and highly stigmatized behavior. Validation studies conducted before the mid-1980s involving known samples of drug users or urinalysis techniques suggested that drug use was fairly accurately reported in self-report surveys. However, more recent validation studies conducted with criminal justice and former treatment clients using improved urinalysis techniques and hair analyses demonstrate that self-report methods miss a lot of recent drug use. A review of the research literature suggests that neither self-reports nor bioassays are wholly accurate, and both have inherent problems. However, because self-report measures are necessary to understand the complexity of causal and correlational attributes of drug abuse, it is necessary to determine what can be done to improve valid self-reporting. This chapter examines the research literature on validation studies to provide an overview of what is known about the accuracy of self-reported drug use.

Health Surveys↗

PubMedDate not supplied

Management of radiologic archive in a diagnostic imaging department.

One of the major and demanding problems in the management of a modern department of Radiology is undoubtedly the organization of a radiologic archive. Its management has been increasingly difficult in last years both for the increase in procedures and the number of radiologic exams. At the Radiology department of UCSC, since some years, this problem has been tackled. Major objectives have been identified in focusing on responsibilities, global management and planning of radiologic film retrieval and archiving integrated with health care activities (scheduling of admissions and exam appointments, reporting, discharge). Based on these assumptions, the archive has been divided into 3 sections, each dynamically integrated with the others. The 3 archives should be integrated with RIS and supported by information technology. RIS is considered the starting point of the process. In fact the system ensures communication to the archiving workstation and to the radiology room of patient admission and consequent execution of the exam which involves image production. This user-friendly procedure enables consistent information between RIS and archiving system and correct association of images to the patient medical report, for subsequent consultation.

Appointments and Schedules↗

PubMed2000

Involvement of community pharmacists in the care of drug misusers: pharmacy-based supervision of methadone consumption.

This article examines the feasibility and acceptability of a supervised consumption of methadone service from local community pharmacies. It builds upon the British Department of Health's recommendations to increase the involvement of community pharmacists in the care of addicted drug users and to expand the range of services they offer to drug users. The article also takes up the ongoing debate on regulating the structure of prescribing and dispensing of methadone and the Department of Health's suggestion to consider methods to reduce the diversion of methadone, for example via supervised consumption of methadone. The pharmacy-based supervised self-administration of methadone scheme (SSA) at the Camden and Islington Community Health Services Trust Substance Misuse Services (CTDS) in London has been found to be valuable by clients, pharmacists and keyworkers. All pharmacists involved regarded the project as workable and expressed their willingness to continue with the provision of supervised dispensing of methadone in the future. Clients stated as main advantages: local access, which saved them time and travelling, and the longer opening hours enabled them flexibility in managing their time. The main negative comments were related to lack of privacy when drinking their methadone within the pharmacy. Most keyworkers welcomed the SSA scheme as another dispensing option available. The fact that another responsible and accountable health professional was involved was positively perceived by the key workers. The Camden and Islington pilot project of providing a supervised consumption of methadone service from local community pharmacies has successfully put into practice the Department of Health's recommendations to increase the involvement of community pharmacists in the care of addicted drug users and to expand the involved health range of services they offer to drug users. This suggests a positive future for the practice and implementation of pharmacy-based self-administered provision of methadone.

Journal Article↗

PubMed1982

[Responsibility in the prevention of accidents of the most exposed pedestrians: children and elderly persons].

A study has been carried out on the Swiss road accidents statistics involving pedestrians. The most exposed road users (young and aged pedestrians) are the ones best protected by traffic law. However, data suggest that these pedestrians are more frequently declared responsible for the accidents in which they are involved. Arising from this contradiction, both the notion of responsibility and the way the prevention of these accidents is conceived should be queried.

Accident Prevention↗

PubMed1979

Pretreatment roles and therapeutic environment as correlates of in-treatment client "success": the case of the nonopiate user.

This study examined the effect of pretreatment role-involvements and therapeutic environment on the levels of in-treatment success for a sample of 704 nonopiate users. Within this sample, treatment type was found to be of little consequence in predicting success on selected measures of performance. The results of the analysis are interpreted as a function of theoretical difficulties in the paradigm that is used to organize the treatment effort.

Adult↗

PubMed2003

Collision and violation involvement of drivers who use cellular telephones.

The study sample consisted of 3,869 drivers, split approximately 50/50 between observed cell phone users and those observed not using cell phones (labeled "nonusers"). Cell phone use was determined by a snapshot observation made on city streets. The sample represented 54% of those originally observed, for whom a match was obtained for both vehicle license plate and for gender and estimated age group of the observed driver and that of the driver named in the vehicle policy. Data were obtained from records of insurance claims, police-reported collisions and violations, following a strict protocol to protect individual privacy. The dependent measures were at-fault crash claims and "inattention" violations. A logistic regression model controlled for age, gender, exposure (represented by not-at-fault crash claims), alcohol-related offenses, and aggressive driving offenses. The study also involved a comparison of the contributing factors and collision configurations of police-reported collisions involving the users and "nonusers" in the sample. Drivers observed using cell phones had a higher risk of an at-fault crash than did the "nonusers," although the difference was not significant for males. There was no apparent effect on "inattention" violations. The cell phone users also had a higher proportion of rear-end collisions. The violation pattern of cell phone users suggests that they are, in general, riskier drivers. These differences likely reflect lifestyle, attitude and personality factors. It is essential to control for these factors in assessing the direct risk attributable to cellular telephone use.

Accidents, Traffic↗

PubMed1997

Telematics and smart cards in integrated health information system.

Telematics and information technology are the base on which it will be possible to build an integrated health information system to support population and improve their quality of life. This system should be based on record linkage of all data based on the interactions of the patients with the health structures, such as general practitioners, specialists, health institutes and hospitals, pharmacies, etc. The record linkage can provide the connection and integration of various records, thanks to the use of telematic technology (either urban or geographical local networks, such as the Internet) and electronic data cards. Particular emphasis should be placed on the introduction of smart cards, such as portable health cards, which will contain a standardized data set and will be sufficient to access different databases found in various health services. The inter-operability of the social-health records (including multimedia types) and the smart cards (which are one of the most important prerequisites for the homogenization and wide diffusion of these cards at an European level) should be strongly taken into consideration. In this framework a project is going to be developed aiming towards the integration of various data bases distributed territorially, from the reading of the software and the updating of the smart cards to the complete management of the patients' evaluation records, to the quality of the services offered and to the health planning. The applications developed will support epidemiological investigation software and data analysis. The inter-connection of all the databases of the various structures involved will take place through a coordination center, the most important system of which we will call "record linkage" or "integrated database". Smart cards will be distributed to a sample group of possible users and the necessary smart card management tools will be installed in all the structures involved. All the final users (the patients) in the whole network of services involved will be monitored for the duration of the project. The system users will also include general practitioners, social workers, physicians, health operators, pharmacists, laboratory workers and administrative personnel of the municipality and of the health structures concerned.

Aged↗

PubMed2004

An analysis of occupational dysphonia diagnosed in the North-East of Poland.

OBJECTIVE: The objective of the study was to evaluate factors predisposing to occupational dysphonia in a group of professional voice users. MATERIAL AND METHODS: The study involved 374 patients treated in the Clinic of Otolaryngology and the Phoniatric Outpatient Clinic, Department of Otolaryngology, Medical University of Białystok in 1999--2001. Group I consisted of 309 patients qualified as professional voice users. The obtained results were compared with those yielded in a group of 65 persons of other occupations (group II). All the diagnosed patients neither smoked nor abused alcohol. Tobacco smokers, patients with chronic diseases of the respiratory system or individuals exposed to irritating vapors were excluded from the study. The clinical evaluation included phoniatric examinations with use of videoendoscopy (VIS) and videolaryngostroboscopy (VLSS) of the larynx. Based on the larynx endoscopic image the voice organ pathology was diagnosed in the patients as functional and/or organic dysphonia. The former comprised hyperfunctional or hypofunctional dysphonia and insufficiency of the glottis and the latter other laryngeal disturbances. In the statistical analysis chi2 parametric test of independence for two averages was used. RESULTS AND CONCLUSIONS: Female teachers of primary and lower secondary schools, mean age 43 years, prevailed in the group of professional voice users, in which functional dysphonia was more common. In this group, the onset of organic changes was earlier than that of functional changes and was manifested by soft vocal nodules, edematous and inflammatory changes in the vocal fold mucosa. Functional dysphonia of 3 degrees, 4 degrees and even 5 degrees predominated in the group of professional voice users in the course of their employment.

Adult↗