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[Registration of accidents and injuries in primary health care. Methods and the users' experiences].

The registration of accidents and injuries in primary health care is inadequate. One of the reasons for this inadequacy is most certainly lack of enthusiasm although lack of to-the-point registration methods is just as much to blame. We have used an automatic accident registration mode in the PC programme Profdoc. This accident registration programme is very useful and time cost-effective. In Os municipality, where the registration took place in 1996, the results have proved to be very helpful in accident prevention. Nevertheless, the programme still needs EDB-knowledgeable doctors, to collect the data. In the near future it will hopefully be possible to feed the raw material to a server, which would then organize the data. This would provide general practitioners with a completed report in exchange for raw material.

Accidents↗

The lessons of user fee experience in Africa.

This paper reviews the experience of implementing user fees in Africa. It describes the two main approaches to implementing user fees that have been applied in African countries, the standard and the Bamako Initiative models, and their common objectives. It summarizes the evidence concerning the impact of fees on equity, efficiency and system sustainability (as opposed to financial sustainability), and the key bottlenecks to their effective implementation. On the basis of this evidence it then draws out three main sets of lessons, focusing on: where and when to implement fees; how to enhance the impact of fees on their objectives; and how to strengthen the process of implementation. If introduced by themselves, fees are unlikely to achieve equity, efficiency or sustainability objectives. They should, therefore, be seen as only one element in a broader health care financing package that should include some form of risk-sharing. This financing package is important in limiting the potential equity dangers clearly associated with fees. There is a greater potential role for fees within hospitals rather than primary facilities. Achievement of equity, efficiency and, in particular, sustainability will also require the implementation of complementary interventions to develop the skills, systems and mechanisms of accountability critical to ensure effective implementation. Finally, the process of policy development and implementation is itself an important influence over effective implementation.

Africa↗

Carers' and Users' Expectations of Services--User version (CUES-U): a new instrument to measure the experience of users of mental health services.

BACKGROUND: No existing instrument measures all or even most of the issues considered important by users of mental health services. AIMS: To develop and test a self-assessment instrument to enable users of mental health services to rate their experience across the range of domains that they consider to be important. METHOD: Relevant domains were identified and a new instrument was drafted and field tested to examine its psychometric properties. RESULTS: The 17-item, self-rated Carers' and Users' Expectations of Services--User version (CUES-U) appears acceptable to most service users. Its items have reasonable test-retest reliability and a 'total CUES-U score' correlates significantly with a total score of the Health of the Nations Outcome Scales (Spearman's rho=0.42; P < 0.01). CONCLUSIONS: The development and testing of CUES-U suggest that it might be feasible to apply a self-rated measure of the expectations and experience of users of mental health services.

Adolescent↗

Technology assessment in a user perspective--experiences with drug technology.

Drugs have a central place among medical technologies, and medical technology assessment can learn from the established regulation of drug technology. This article outlines how users' experiences are not part of the basis on which decisions are made today, although this knowledge is imperative for identifying the problems that are not uncovered or foreseen by today's drug assessments. Further, users' interests might not be part of assessments that are based on the controlled clinical trial. A framework for drug technology assessments based on a user perspective is suggested.

Denmark↗

Binaural sensitivity as a function of interaural electrode position with a bilateral cochlear implant user.

Experiments were conducted with a single, bilateral cochlear implant user to examine interaural level and time-delay cues that putatively underlie the design and efficacy of bilateral implant systems. The subject's two implants were of different types but custom equipment allowed presentation of controlled bilateral stimuli, particularly those with specified interaural time difference (ITD) and interaural level difference (ILD) cues. A lateralization task was used to measure the effect of these cues on the perceived location of the sensations elicited. For trains of fixed-amplitude, biphasic current pulses at 100 pps, the subject demonstrated sensitivity to an ITD of 300 micros, providing evidence of access to binaural information. The choice of bilateral electrode pair greatly influenced ITD sensitivity, suggesting that electrode pairings are likely to be an important consideration in the effort to provide binaural advantages. The selection of bilateral electrode pairs showing sensitivity to ITD was partially aided by comparisons of the pitch elicited by individual electrodes in each ear (when stimulated alone with fixed-amplitude current pulses at 813 pps): specifically, interaural electrodes with similar pitches were more likely (but not certain) to show ITD sensitivity. Significant changes in lateral position occurred with specific electrode pairs. With five bilateral electrode pairs of 14 tested, ITDs of 300 and 600 micros moved an auditory image significantly from right to left. With these same pairs, ILD changes of approximately 11% of the dynamic range (in microApp) moved an auditory image from the far left to the far right-significantly farther than the nine pairs not showing significant ITD sensitivity. However, even these nine pairs did show response changes as a function of the interaural (or confounding monaural) level cue. Overall, insofar as the access to bilateral cues demonstrated herein generalizes to other subjects, it provides hope that the normal binaural advantages for speech recognition and sound localization can be made available to bilateral implant users.

Acoustic Stimulation↗

Making sense of illness: the experiences of users of complementary medicine.

The present study investigated the experiences of users of complementary and alternative medicine (CAM) using a qualitative approach. In-depth interviews were conducted with 11 frequent users and analysed using interpretative phenomenological analysis (IPA). Results indicated that the patient-practitioner relationship and explanatory frameworks provided by CAM were perceived as important components of the therapeutic process, irrespective of treatment efficacy. CAM served a variety of functions beyond the explicit relief of symptoms by increasing energy and relaxation, facilitating coping and enhancing self/other awareness. It is therefore important that these wider effects are taken into account when evaluating complementary medicine in order to reflect patients' experiences accurately.

Adaptation, Psychological↗

'Small group' rehabilitation in adolescent cochlear implant users: learning experiences.

The reasons for which a group approach has been chosen for the small group rehabilitation of adolescent cochlear implant users are discussed. The most significant learning experiences after 18 months of treatment were the socialization of experience, the socialization of individual learning processes, the direct relationship between adolescents, practice discussion of topics of common interest, emphasizing of personal opinions and beliefs, experiencing collective 'products', the reinforcement of interpersonal relationships and the emphasizing of individual initiatives both at home and at school.

Adolescent↗

Cancer as a chronic illness? Reconsidering categorization and exploring experience.

This article explores the different ways that user experience is defined and conceptualized, and the various policy and professional contexts in which emphasis is placed on exploring users' views. We go on to examine the experience of cancer as a chronic illness and argue that, although there are common features in the experience of cancer and people with chronic illness, the differences are too significant and cancer should not be defined as a chronic condition. We conclude with a consideration of the methodological difficulties of documenting user experience and identify the need for further methodological development.

Adaptation, Psychological↗

Syringe vending machines for injection drug users: an experiment in Marseille, France.

OBJECTIVES: This study evaluated the usefulness of vending machines in providing injection drug users with access to sterile syringes in Marseille, France. METHODS: Self-administered questionnaires were offered to 485 injection drug users obtaining syringes from 32 pharmacies, 4 needle exchange programs, and 3 vending machines. RESULTS: Of the 343 respondents (response rate = 70.7%), 21.3% used the vending machines as their primary source of syringes. Primary users of vending machines were more likely than primary users of other sources to be younger than 30 years, to report no history of drug maintenance treatment, and to report no sharing of needles or injection paraphernalia. CONCLUSIONS: Vending machines may be an appropriate strategy for providing access to syringes for younger injection drug users, who have typically avoided needle exchange programs and pharmacies.

Adolescent↗

Prescribing drug of choice to illicit heroin users: the experience of a U.K. community drug team.

Functioning across several life domains, in the first cohort of illicit heroin users to be prescribed injectable diamorphine (pharmaceutical heroin) as an adjunct to treatment within a community drugs service, was assessed in a cross-sectional study with a 6-month follow-up. Case-control matching procedures were employed to compare outcomes in this group with an oral methadone-prescribed sample, attending different clinics within the same community service and geographical locale. The Heroin Prescribed (HP) group manifested lower levels of psychopathology and showed greater retention in treatment. Although reduced, illicit heroin misuse was not eliminated; the use of other illicit substances was comparable between groups but significantly more of the HP group were using illicit cocaine. Although no differences in current physical health were apparent, the sharing of used injecting equipment was reported only in the MP group. Criminal activity appeared significantly reduced, but not eliminated, in the HP group. Implications for prescribing practice are discussed.

Adult↗

Psychiatric barriers to readiness for treatment for hepatitis C Virus (HCV) infection among injection drug users: clinical experience of an addiction psychiatrist in the HIV-HCV coinfection clinic of a public health hospital.

Among injection drug users, psychological and psychiatric barriers to readiness for treatment for hepatitis C virus (HCV) infection include mood and anxiety disorders, cognitive deficits, temperament disorders, and personality vulnerabilities, as well as ongoing drug use. Many aspects of these barriers can be overcome with direct treatment or social support. To establish effective treatment for HCV infection in this population of patients, it is essential that the patient and providers develop a rapport that allows for active communication. It is also important that the patient make an effort to adhere to the treatment requirements and that the patient receive the appropriate evaluation and management of treatable barriers.

Adult↗

Vaginal bleeding patterns in women using once-a-month injectable contraceptives.

The main raison d'être for the development of once-a-month injectable contraceptives is the need for a long-acting method which produces a regular vaginal bleeding pattern. Although many women will successfully tolerate the amenorrhea or irregular bleeding which frequently accompany use of long-acting progestogen-only methods, there is a substantial minority, especially in certain ethnic groups, who find this unacceptable. The extensive literature does indicate that although combined estrogen-progestogen once-a-month injectables produce much more regular bleeding patterns than long-acting injectables like depot-medroxyprogesterone acetate, the patterns are not entirely normal. Detailed studies by the World Health Organization have demonstrated some deviation from normal menstrual patterns by users of the two once-a-month injectables, Cyclofem and Mesigyna. For example, 23.5% of Cyclofem and 25.2% of Mesigyna users experience irregular bleeding between 3 and 6 months of use compared with 4.8% of untreated women, and 13.3% of Cyclofem and 11.1% of Mesigyna users experience prolonged bleeding compared with 2.3% of untreated women. Comparable figures are much worse for DMPA users with a 35.7% incidence of irregular and 27.7% incidence of prolonged bleeding after similar duration of use. Bleeding patterns with all long-acting methods tend to improve with time. Overall group data for once-a-month injectable users are reasonably close to those of untreated women with, for example, a median of 15.6 days (5th and 95th percentiles: 7.5 and 26; confidence limits) of bleeding or spotting per 90-day reference period compared with a median of 18.5 days (5th and 95th percentiles: 12.2 and 25.5) for untreated women. Twelve-month life table discontinuation rates for menstrual bleeding disturbances are lower than expected for most progestogen-only methods at 2.1-5.2% for Cyclofem and 0.8-4.2% for Mesigyna for amenorrhea, and 6.3-12.7% for Cyclofem and 7.5-12.0% for Mesigyna for bleeding-related reasons. Once-a-month injectable contraceptives produce vaginal bleeding patterns much closer to normal than other injectables, but there are still significant deviations which lead to some discontinuation for menstrual reasons. Hence, full explanation and counselling about possible menstrual changes are still essential for all intending users of these methods.

Contraceptive Agents, Female↗

Preventing the spread of HIV in injecting drug users--the experience of syringe-exchange schemes in England and Scotland.

In 1987 the UK government launched experimental schemes for distributing injecting equipment to injecting drug users in order to help prevent the spread of Human Immunodeficiency Virus. This paper reports on the first few months of the schemes, and provides some initial evidence of changes in clients' risk behaviours. The schemes have been reasonably successful in attracting clients, but are less successful in retaining them. Schemes have demonstrated that equipment can be distributed to clients on an exchange basis. Schemes have reached new groups of clients, including many without previous or current treatment contact or other help for their drug problems. The baseline assessment of clients found that most had accurate knowledge of the risk of infection from sharing injecting equipment. Most thought that they were at low risk of infection. Syringe sharing in the last four weeks was reported by 36%. A minority engaged in multiple sharing. Most clients were sexually active and many had partners who did not inject drugs. The main reason for attendance was worry about AIDS, and a majority of clients reported that they had already made changes in their injecting practices because of AIDS. Some reported changes in sexual behaviour. A sample of clients followed-up at 2-4 months indicates a reduction in syringe sharing.

Acquired Immunodeficiency Syndrome↗

'Therapy as well as the tablets': an exploratory study of service users' views of community mental health nurses' (CMHNs) responses to hearing voices.

Mental health nurses have traditionally been discouraged from engaging with service users' experiences of hearing voices and to reinforce reality. However, this may not be a helpful way of intervening in what can be a very distressing symptom. There is little evidence of service users' experiences of community mental health nurses' (CMHNs) responses to their voices. This paper presents the findings of an exploratory interview study of a sample (n = 20) of service users to ascertain their perception of CMHN responses to their experience of hearing voices. Data are both quantitative and qualitative in nature. Content analysis of the qualitative elements of the study suggests responses can be conceptualized as facilitators, barriers and attributions. CMHNs are considered to be allies and the quality of the relationship is deemed important. The therapeutic repertoire of CMHNs, however, is seen as limited and rarely extends beyond facilitating access to the psychiatrist for review of medication.

Adult↗

The quest for well-being: a qualitative study of the experience of taking antipsychotic medication.

Antipsychotic medication is integral to the treatment of severe and enduring mental health problems (e.g. schizophrenia). Such medication is associated with significant adverse side effects that can affect treatment adherence. To date there have been few attempts to analyse qualitatively service users' experience of taking antipsychotic medication. This study, conducted in Exeter, South West England, investigates the subjective experience of side effects of antipsychotic medication to gain a greater understanding of service users' experiences and to gain insights into adherence issues. Data were analysed using a variant of grounded theory (Glaser and Strauss, 1967) and a model of the experience of taking antipsychotic medication was constructed. The interview schedule was then refined and further interviews (including a focus group) were conducted among a diverse sample recruited from local day centres. Results indicated that people taking antipsychotic medication do not see side effects and symptoms as separate issues. Instead, they describe drugs as 'good' or 'terrible'-an indication of the total impact of their treatment. The model constructed reflects this, having the core concept of Well-being: that is, normality of function, feeling and appearance to the outside world. Major themes relating to this core category were managing treatment, evaluating treatment and understanding of the situation. Implications for medication adherence and clinical practice, including drug choice, are discussed, and the doctor-patient relationship is also considered.

Adult↗

Bandwidth constraints to using video and other rich media in behavior change websites.

BACKGROUND: Web-based behavior change interventions often include rich media (eg, video, audio, and large graphics). The rationale for using rich media includes the need to reach users who are not inclined or able to use text-based website content, encouragement of program engagement, and following the precedent set by news and sports websites. OBJECTIVES: We describe the development of a bandwidth usage index, which seeks to provide a practical method to gauge the extent to which websites can successfully be used within different Internet access scenarios (eg, dial-up and broadband). METHODS: We conducted three studies to measure bandwidth consumption. In Study 1, we measured the bandwidth usage index for three video-rich websites (for smoking cessation, for caregivers, and for improving eldercare by family members). We then estimated the number of concurrent users that could be accommodated by each website under various Internet access scenarios. In Study 2, we sought to validate our estimated threshold number of concurrent users by testing the video-rich smoking cessation website with different numbers of concurrent users. In Study 3, we calculated the bandwidth usage index and threshold number of concurrent users for three versions of the smoking cessation website: the video-rich version (tested in Study 1), an audio-rich version, and a Web-enabled CD-ROM version in which all media-rich content was placed on a CD-ROM on the client computer. RESULTS: In Study 1, we found that the bandwidth usage index of the video-rich websites ranged from 144 Kbps to 93 Kbps. These results indicated that dial-up modem users would not achieve a "good user experience" with any of the three rich media websites. Results for Study 2 confirmed that usability was compromised when the estimated threshold number of concurrent users was exceeded. Results for Study 3 indicated that changing a website from video- to audio-rich content reduced the bandwidth requirement by almost 50%, but it remained too large to allow satisfactory use in dial-up modem scenarios. The Web-enabled CD-ROM reduced bandwidth requirements such that even a dial-up modem user could have a good user experience with the rich media content. CONCLUSIONS: We conclude that the bandwidth usage index represents a practical tool that can help developers and researchers to measure the bandwidth requirements of their websites as well as to evaluate the feasibility of certain website designs in terms of specific use cases. These findings are discussed in terms of reaching different groups of users as well accommodating the intended number of concurrent users. We also discuss the promising option of using Web-enabled CD-ROMs to deliver rich media content to users with dial-up Internet access. We introduce a number of researchable themes for improving our ability to develop Web-based behavior change interventions that can better deliver what they promise.

Attitude to Health↗

Materials management information systems.

The hospital materials management function--ensuring that goods and services get from a source to an end user--encompasses many areas of the hospital and can significantly affect hospital costs. Performing this function in a manner that will keep costs down and ensure adequate cash flow requires effective management of a large amount of information from a variety of sources. To effectively coordinate such information, most hospitals have implemented some form of materials management information system (MMIS). These systems can be used to automate or facilitate functions such as purchasing, accounting, inventory management, and patient supply charges. In this study, we evaluated seven MMISs from seven vendors, focusing on the functional capabilities of each system and the quality of the service and support provided by the vendor. This Evaluation is intended to (1) assist hospitals purchasing an MMIS by educating materials managers about the capabilities, benefits, and limitations of MMISs and (2) educate clinical engineers and information system managers about the scope of materials management within a healthcare facility. Because software products cannot be evaluated in the same manner as most devices typically included in Health Devices Evaluations, our standard Evaluation protocol was not applicable for this technology. Instead, we based our ratings on our observations (e.g., during site visits), interviews we conducted with current users of each system, and information provided by the vendor (e.g., in response to a request for information [RFI]). We divided the Evaluation into the following sections: Section 1. Responsibilities and Information Requirements of Materials Management: Provides an overview of typical materials management functions and describes the capabilities, benefits, and limitations of MMISs. Also includes the supplementary article, "Inventory Cost and Reimbursement Issues" and the glossary, "Materials Management Terminology." Section 2. The MMIS Selection Process: Outlines steps to follow and describes factors to consider when selecting an MMIS. Also includes our Materials Management Process Evaluation and Needs Assessment Worksheet (which is also available online through ECRInet(TM)) and a list of suggested interview questions to be used when gathering user experience information for systems under consideration. Section 3A. MMIS Vendor Profiles: Presents information for the evaluated systems in a standardized, easy-to-compare format. Profiles include an Executive Summary describing our findings, a discussion of user comments, a listing of MMIS specifications, and information on the vendor's business background. Section 3B. Discussion of Vendor Profile Conclusions and Ratings: Presents our ratings and summarizes our rationale for all evaluated systems. Also includes a blank Vendor Profile Template to be used when gathering information on other vendors and systems. We found that, in general, all of the evaluated systems are able to meet most of the functional needs of a materials management department. However, we did uncover significant differences in the quality of service and support provided by each vendor, and our ratings reflect these differences: we rated two of the systems Acceptable--Preferred and four of the systems Acceptable. We have not yet rated the seventh system because our user experience information may not reflect the vendor's new ownership and management. When this vendor provides the references we requested, we will interview users and supply a rating. We caution readers against basing purchasing decisions solely on our ratings. Each hospital must consider the unique needs of its users and its overall strategic plans--a process that can be aided by using our Process Evaluation and Needs Assessment Worksheet. Our conclusions can then be used to narrow down the number of vendors under consideration...

Computer Security↗