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Feasibility and acceptance of a home telemanagement system in patients with inflammatory bowel disease: a 6-month pilot study.

Our purpose was to assess the acceptance and feasibility of a home telemanagement system (HAT) in inflammatory bowel disease (IBD). The HAT consists of a laptop and a scale. Subjects were required to complete weekly self-testing for 6 months. Disease activity, quality of life, and knowledge were assessed at baseline and 6 months. Attitudinal surveys were completed at 6 months. Twenty-five subjects completed the study. Ninety-one percent of patients thought that self-testing was not complicated. Eighty-six percent said that self-testing did not interfere with their usual activities. Ninety-one percent of patients would consider using a HAT in the future. Adherence with self-testing was 91%. Improvements in disease activity and quality of life, and significant improvements in knowledge, were observed after implementation of the HAT. The HAT is feasible and accepted in IBD. We predict that the HAT will positively affect adherence, monitoring, and patient education, resulting in improved disease activity and quality of life.

Adult↗

The Dutch 'Benefit-II' project: do physicians benefit from using an electronic medical dossier?

In 1992 the Dutch College of General Practitioners (NHG) started a project, which lasted until May 1994. The project had three major objectives: establishing as exactly as possible what benefits we gain from using an Electronic Medical Dossier (EMD) can we find an influence on the quality of care? Which drawbacks or problems are there, advising on the optimal use of an EMD; What is the best place to record certain data? advising the Working Committee on Informatics (WCIA), of Dutch National Association of General Practitioners (LHV) and NHG on the directions for the new Reference Model 1995. To obtain these goals panel discussions and a questionnaire were used. The project resulted in advice on how to use the EMD in the most efficient way. Also we have learned about the use of GP-information systems and the perception about this usage by the Dutch GPs.

Computer Literacy↗

Implementation of an electronic patient data management system (PDMS) on an intensive care unit (ICU).

Implementation of a data management system on an Intensive Care Unit (ICU) needs a good organisation. The expectations and the specifications of the system should be defined and clear before the process is started. Analysis of produced data of communication and information pathways on the ICU is necessary. A complete system should include data acquisition, data base management and archiving of data. In our project, the development of these criteria was performed by participation in a national project. Coupling with a hospital information system and the possibility of data exchange is mandatory. We were able to implement a paperless patient record. Although it takes more time to do the patients administration with a Patient Data Management System (PDMS), medical personal seem to be better informed. Readable information is easy to access at the bedside of the patient.

Attitude to Computers↗

The Staggers Nursing Computer Experience Questionnaire.

This report described the development and initial psychometric testing for an instrument measuring nurses' perceived computer experience. The instrument's theoretical basis was psychometric theory and innovation adoption, specifically innovation use and knowledge. The scored portion of the instrument asks nurses to rate their past or present computer use and knowledge for general computer and HIS applications as well as participation in and knowledge about informatics role activities. A descriptive section of the tool asks nurses to indicate the number of formal courses and college-level computer/informatics courses they have taken. A novice-to-expert scale allows nurses to indicate their overall computer experience. Additionally, nurses list reasons, if any, that they might not use computers often. Content and construct validity were adequate for the instrument. Test-retest reliability indicated beginning reliability for the tool. The SNCEQ provides a reliable and valid measure for assessing nurses' past and present computer experience.

Adult↗

Discharge planning, nursing home placement, and the Internet.

BACKGROUND: Effective discharge planning and well-coordinated case management related to nursing home (NH) placement are key services in acute-care hospitals. OBJECTIVES: (1) identify the individuals and important factors involved in the discharge planning process; (2) describe the types/sources of information used by discharge planners to recommend specific nursing homes for patients and families; and (3) determine which methods are used to evaluate the quality of US nursing homes (NHs). METHODS: Descriptive study, with a convenience sample of 41 discharge planners and case managers from California acute-care hospitals. RESULTS: This study found that patients, families, friends, and physicians are all involved in the discharge planning process along with discharge planners and/or case managers. Discharge planners/case managers were generally concerned about NH bed availability, geographic location, and financial considerations. Although the discharge planners and case managers were able to articulate important indicators of quality in NHs, such information was not routinely considered during discharge planning activities. CONCLUSIONS: Discharge planners and case managers need to play a more central role in the decision-making process related to the selection of a NH, especially because decisions are time-limited and can benefit from a well-planned discharge planning program that uses a variety of data on quality and costs. The widespread use of Internet-based information sources can be expanded to aid this process.

Attitude of Health Personnel↗

It's good to talk: comparison of a telephone helpline and website for cancer information.

The Internet plays an important role in the information gathering process for people affected by cancer. This paper presents the results of a study comparing two sources of cancer information; a website and a telephone helpline. Data were captured on the use of one section of the UK charity CancerBACUP's website, and systematically compared to data collected from every fifth user of the charity's helpline. Subjects of enquiry for 994 telephone enquiries and 3096 web enquiries were comparable. The majority of enquiries to both services were about women and/or patients aged 50 or older. Website users were more likely than helpline users to request factual information and less likely to request information on sensitive topics. This study provides valuable information about the types of health information people seek from different sources and how the sources may complement each other.

Adult↗

Promoting and evaluating competence in on-line dietetics education.

Professional organizations, such as the American Dietetic Association are challenged to assure competency of their practitioners. Competency includes higher-level skills such as critical-thinking, cooperative work, effective communication, and use of lifelong learning resources. Information literacy via computer technology is a key component of competency, which needs to be included in dietetic education and training. This dietetic internship examined use of online technology to develop competency using the key-feature exam. Seventy-five dietetic interns from three different programs were divided into those with (n = 44) and without (n = 31) online instruction, to which pre- and post- test key feature exams were administered. Those with online instruction had greater improvement (P < 0.05) on key-feature exams in nutrition support and pediatric nutrition. Competency is complex and difficult to assess, thus tools to better assess the comprehensive scope of practitioner competency are needed. The key-feature exam may be a tool to assess and verify practitioner competency in dietetics professionals.

Adult↗

Interactive computer-based cognitive training in patients with Alzheimer's disease.

The present paper presents data from ten patients suffering from mild to moderate Alzheimer's disease (AD), all of whom were trained to use an interactive computer-based program. Using photographs of the patient and his or her personal surroundings, an everyday task of relevance to the patient was simulated on a PC-touch screen, which the patient was trained to operate. After three weeks of training (three to four sessions a week), the patients needed less help in performing the programs, they became faster, and eight out of ten made fewer mistakes. The results were most pronounced in patients with a poor performance at the beginning, and there was no difference between early-onset (EO) and late-onset (LO) AD patients. Although the training was generally well received, there was no evidence of a general cognitive improvement, and it remains an open question whether the results achieved with PC training can be transferred to real-life situations.

Activities of Daily Living↗

What do patients with prostate or breast cancer want from an Internet site? A qualitative study of information needs.

The study aimed to explore the information needs of cancer patients, to solicit their views of Internet-based health information and to consider whether the DIPEx website would have addressed specific unmet information needs of people with breast or prostate cancer. Focus groups were conducted first to identify information needs. Participants were recruited through four breast and prostate cancer support groups in the UK. Individual interviews, in which participants were shown DIPEx and asked to search for material related to concerns that had been important to them as cancer patients, were conducted after the focus groups. Respondents said their information needs had been complex and changed over time while the information they had been given was often patchy, inconsistent, contradictory and haphazard. Access to practical and experiential information from other patients was highly valued. Those with experience of using the Internet expressed a clear preference for non-commercial sites for health information. Sites attached to recognised centres of excellence such as universities or well-known medical centres were also preferred. Respondents were aware of the possible pitfalls of taking health information from the Internet and often compared information from several sources before believing it.

Adult↗

An assessment of the feasibility of telephone and email consultation in a chest clinic.

One hundred and sixty-four consecutive patients attending a busy respiratory outpatient service were asked how acceptable was the concept of alternating face to face consultation with consultation by either telephone or email. The patients were then assessed as to their suitability for such non-traditional methods of consultation. Thirty patients (18.3%) were not agreeable to other forms of consultation and five could not speak English. One hundred and thirty-three (84%) had a suitable daytime telephone number for consultation purposes, but only 34 (21%) had email access, with this being commoner in the younger ages. One hundred and five patients were not thought to be suitable for alternative methods of consultation because of: the severity of their condition, the difficulty of assessing it over the telephone, or because they needed to attend the hospital for investigations. However, even in a clinic where the policy was already to return as many patients as possible to the care of their primary care physicians, and in a clinic where much work was already shared with respiratory nurse specialists, over one-third of patients were thought to be suitable for alternating face to face with telephone consultation. The diagnoses in those cases included asthma, suspected obstructive sleep apnoea, chronic obstructive pulmonary disease (COPD), unexplained cough, and some patients with respiratory malignancy being visited at home by the palliative medicine services. However, for those with asthma and for those awaiting results of investigations especially, use of telephone consultation appears to be an acceptable and convenient way of reducing the pressure upon time available for face to face consultations.

Computer Literacy↗

They were different and few: an Australian study of midwives' attitudes to research and computerised research findings.

This study sought to determine factors influencing the utilisation of research findings by Australian midwives before and after exposure to an on-line research database within their practice setting. The setting was a large maternity hospital in South Australia and data were collected via pre and post intervention questionnaires. 14 midwives from the Delivery Suite and Birth Centre of this hospital participated in the study. Midwives showed an increased receptivity to the concept of computerised research findings after exposure to the database. They rated research as highly important to providing quality midwifery care and for the midwifery profession, and saw midwives as the key players in maternity care research. These findings are not in keeping with previous research--largely accounted for, we believe, by the particular, and small number of, midwives who volunteered to participate in the study (24% of those invited).

Adult↗

Informed decisions by clinicians are fundamental for EPR implementation.

Most often the investment in electronic patient records (EPR) is decided upon on the basis of descriptions of all the advantages this new technology will bring. We argue that an exchange of a paper-based patient record (PPR) with an EPR is an efficient way to automate manual routine work and distribute information but the real benefits from EPR depend on how clinicians use an EPR application to improve the quality of care. We introduce the 'price to pay' concept in order to illustrate that it takes a human effort to create better health care and that clinicians therefore play a very important role when implementing EPR systems.

Computer Literacy↗

A multimedia approach to raising awareness of information and communications technology amongst healthcare professionals.

This study is concerned with the application of advanced multimedia technology to the development of a programme aimed at raising awareness of information and communications technology (ICT) amongst health professionals in Ireland. The programme is delivered in the form of a symposium supplemented by a multimedia CD and associated web site. It examines how ICT can be used effectively in healthcare across all sectors - primary, secondary and tertiary - with a strong emphasis on supporting shared care. The aim is to empower users to make informed technological choices and to actively participate in the exploitation of ICT in the health sector. The programme was successfully completed and delivered to over 2300 health professionals across Ireland and follow-up activities include the active encouragement of leaders and champions within the sector. This will be supported by interactive web-based education and training material focused on specialised topics of particular interest within the broader context of continuing medical education (CME).

Computer Literacy↗