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PubMed2006

Evaluation of a redesigned self-checkout station for wheelchair users.

Self-checkout is the emergent/emerging retail technology wherein users (shoppers) check out their own items using an interactive kiosk. A dramatic growth is anticipated in the prevalence of self-checkout systems in retail environments. A study was conducted to develop and evaluate a redesign of a self-checkout system with a focus on issues related to physical accessibility for wheelchair users. Two checkout station prototypes were built: a full-scale model of an existing system and a full-scale model of a system with design modifications (e.g., inclusion of appropriate wheelchair clearance under the workstation, reduced vertical position of the credit card reader, etc.). Five wheelchair users and 10 non-wheelchair users performed simulated self-checkout activities using both workstations. The principal independent variable was workstation type (standard design vs. modified design). The dependent measures were productivity (time to complete a transaction), shoulder flexion angle, torso flexion angle, and the user's subjective assessment of the experience. The results of this study indicate that workstation type did not influence productivity levels in either participant group (wheelchair users or non-wheelchair users). Posture, on the other hand, was significantly improved: the peak shoulder angle was reduced by 64% in wheelchair users and by 69% in the non-wheelchair user group. Peak flexion angle of the torso was also reduced by 67% for wheelchair users. Subjective feedback from the wheelchair user group supported the postural data by showing an overall preference for the redesigned workstation, whereas the non-wheelchair group showed no preference between the two. These results indicate that design for populations with specific limitations does not need to come at a cost of reduced accessibility for persons without these limitations; universal design is achievable.

Architectural Accessibility↗
PubMedDate not supplied

Using WWW and JAVA for image access and interactive viewing in an integrated PACS.

We start from the observations that (1) potential benefits from PACS can only be realized if PACS and HIS are integrated into a 'multimedia medical information system', and (2) that this also requires integration at the level of the user interface. The user interface should allow integrated interaction with information from different subsystems, of which PACS is one. However, in the real world, different information systems are constructed using different technologies. Moreover, radiological image viewing is a highly interactive task that puts a particular burden on the graphical user interface. We describe our experiences in applying technology emerging around the 'World Wide Web' (WWW) for interactive access to an integrated PACS/HIS. We illustrate the use of Web browsers to access new medical services, touch technologies for interactive access to HIS-PACS information, and emphasize the potential of JAVA applets. We argue that JAVA may become an important tool for providing highly interactive user interfaces to larger multimedia information systems. We discuss Web technology in the general context of HIS/PACS integration.

Archives↗
PubMed2002

A service users' research advisory group from the perspectives of both service users and researchers.

Much has been written about the importance of involving service users in the research process. Far less is available about the experience of involvement from the perspective of service users themselves. The present paper is a joint account by service users and researchers of a service users' advisory group set up to support and advise a project to evaluate diabetes services in Bradford, UK. The establishment of a separate advisory group for service users is, to our knowledge, an innovative approach to lay involvement within mainstream National Health Service (NHS)-based research. Factors that contributed to the group's success included personal contact, continuity of membership and integration into the management structure of the project. Also valued were the confidence in numbers which membership of the group gave, and the opportunity to meet and discuss issues away from the formal and somewhat intimidating atmosphere of the project's steering group. Aside from the personal value to participants and any impact on the quality of research outcomes, wider benefits included the ability to share knowledge with others and gain greater intercultural understanding.

Advisory Committees↗
PubMed2005

The effects of stereotype threat on cognitive function in ecstasy users.

Stereotype threat occurs when individuals, believed to be intellectually inferior, perform badly on cognitive tests they perceive to confirm stereotypes about them. Due to the wide media coverage of studies purporting to show cognitive deficits in ecstasy users it is possible that they experience stereotype threat. This study tested ecstasy and non-ecstasy using polysubstance misusers on a variety of cognitive tests after they had been exposed to stereotype threat. This priming consisted of exposing them to information about the long-term effects of ecstasy which either stated that ecstasy caused memory loss or that it did not. Ecstasy users that had been primed that ecstasy did not cause cognitive deficits performed better than the other three groups on the delayed portion of the prose recall task from the Rivermead Behavioural Memory Test battery. There were no other statistically significant differences between any of the groups on any of the other cognitive tests used. This suggests that stereotype threat exists in ecstasy users and may be influencing their performance in experiments designed to identify cognitive deficits. In order to prevent this occurring in future studies, experimenters must be careful how they conduct their experiments and discuss their results with the media.

Adolescent↗
PubMed2001

Bilateral hearing aids--effects and consequences from a user perspective.

The present study assesses the experiences with bilateral amplification in a group of 144 people provided with two hearing aids between May 1994 and July 1997. Two-thirds of the participants preferred to use both prescribed hearing aids. The participants reported that they used their hearing aids frequently. Bilateral amplification was appreciated especially for recognizing speech, for sound localization and for superior sound quality. Situations in which the subjects showed the highest appreciation of two hearing aids were when attending lectures and theatre performances and for communication in noisy background situations. There were statistically significant differences between users of bilateral and unilateral hearing aids regarding judgement of sound quality of hearing aid processed signals and localization ability in favour of bilateral hearing aid amplification. The self-assessed advantages of bilateral amplification demonstrated in this study should motivate a generous prescription strategy of two hearing aids.

Acoustic Stimulation↗
PubMed2004

A UK multi-centre experience with a second-generation endovascular stent-graft: results from the Zenith Users Group.

BACKGROUND: Endovascular aneurysm repair has been criticised for high rates of technical failure and secondary intervention. Second generation stent-grafts have been developed in an attempt to reduce these problems. The results of a UK multi-centre experience with a second generation device (Zenith) are presented. METHODS: Data were collected retrospectively from five experienced UK vascular centres in patients undergoing endovascular aneurysm repair with the Zenith stent-graft. RESULTS: A total of 269 patients underwent attempted aneurysm repair with the Zenith device. Median aneurysm diameter was 65 (interquartile range 52-78) mm. There were no conversions to open repair. Peri-operative mortality was 4.1% (11/269). On the initial post-operative scan, 94.1% of aneurysms were successfully excluded. During a median follow-up of 363 (interquartile range 154-720) days there were 19 secondary interventions and two aneurysm ruptures. CONCLUSIONS: Second generation endovascular stent-graft designs such as the Zenith are associated with low rates of intra-operative technical complications. Few secondary interventions have been necessary during follow-up; however, surveillance is essential to ensure they continue to perform.

Aged↗
PubMed2001

Identification of adolescent tobacco users in a pediatric practice.

CONTEXT: Though prevention of adolescent tobacco use is a major public health goal, there is little information on the ability of pediatricians to identify adolescents experimenting with tobacco and regular tobacco users. OBJECTIVES: To pilot use of a short questionnaire and analysis of urinary cotinine level to identify adolescent smokers in a pediatric practice, and to determine characteristics of tobacco users. SETTING: Suburban pediatric practice. METHOD: Consecutive high school students completed a short questionnaire and urine cotinine assessment. Three groups were defined: smokers (urine cotinine level >100 ng/mL), experimenters (smoked within the last year; urine continine level </=100 ng/mL), and nonsmokers. Logistic regression was used to examine characteristics of experimenters. RESULTS: One hundred twenty-four adolescents were enrolled throughout 3 months: 83 nonsmokers (67%), 28 experimenters (23%), and 13 smokers (10%). The questionnaire alone identified 92% of regular smokers. Smoking frequency increased by grade level. Smoking initiation occurred with peers. Compared with nonsmokers, smokers and experimenters were more likely to be older and have a majority of friends who smoked. Smokers were more likely to have a family member who smoked. A majority of smokers and experimenters had tried to quit and understood the adverse health effects of tobacco use. CONCLUSIONS: Adolescent smokers and experimenters were identified using a brief questionnaire. This method will allow pediatricians the opportunity to identify at-risk adolescents before they become regular smokers. Further studies at primary care offices are needed to examine identification of adolescents at highest risk and examine methods to initiate smoking cessation before addiction is established.

Adolescent↗
PubMed2003

Self-reported psychotic experiences in the general population: a valid screening tool for DSM-III-R psychotic disorders?

OBJECTIVE: To examine the diagnostic value of self-reported psychotic-like experiences for DSM-III-R psychotic disorders. METHOD: A general population sample of 7076 subjects aged 18-64 years was interviewed with the Composite International Diagnostic Interview (CIDI) and, if there was evidence of psychotic experiences, the Structured Clinical Interview for DSM-III-R. RESULTS: The probability of having a psychotic disorder increased in a dose-response fashion with the level of self-reported psychotic experiences, but individual CIDI psychotic experience ratings had relatively low post-test probabilities (PPs) (range: 5.1-26.5%). However, limiting the sample to individuals who had been in contact with mental health services substantially improved PPs (range: 13.3-43.1%). CONCLUSION: Screening for psychosis in the population carries a high risk of stigmatization in false-positive cases and violation of the right 'not to know' in true-positive cases. However, in mental health care users, self-reported psychotic experiences may be a useful screening tool in individuals who have already developed help-seeking.

Adult↗
PubMed1999

SAS-CIS preference study in postlingually deafened adults implanted with the CLARION cochlear implant.

This study examined the speech perception performance of 71 postlingually deafened adults implanted with the CLARION Multi-Strategy Cochlear Implant. After 3 months of implant use, one third of the patients (n = 23) preferred to use the Simultaneous Analog Stimulation (SAS) strategy, and two thirds of them (n = 48) chose to use the Continuous Interleaved Sampler (CIS) strategy. The mean CID sentence scores were similar for the SAS and CIS user groups at the 3-month postoperative interval. In contrast, the mean CNC word score of the SAS users was significantly higher than the mean score of the CIS users after 3 months of implant experience. Patients who preferred to use SAS demonstrated significantly shorter duration of deafness at time of implantation than did the CIS users, whereas the CIS users demonstrated significantly higher preoperative sentence recognition scores than the SAS users. The results suggested that access to a preferred processing strategy improved the overall group performance of postlingually deafened adults in the present study compared to the results of previous studies in which only the CIS strategy was available to most patients with the Clarion.

Choice Behavior↗
PubMed2005

A feasible strategy of promoting nursing informatics by End User Computing.

The purpose of this study was to report our experiences in promoting NI training and professorship using the strategy of End User Computing in Taiwan. An interview-based survey was made to better understand the pros and cons of this strategy from three successful projects. The results appear promising and cost-effective.

Computer User Training↗
PubMed2004

Tissue adhesive skills study: the physician learning curve.

OBJECTIVE: To compare 2 educational approaches (structured group session vs. individual instruction) of learning application techniques of 2-octylcyanoacrylate (OCA) on wounds repaired in the emergency department. METHODS: This prospective, nonrandomized, observational study was conducted in an urban hospital emergency department. Medical students, residents, and faculty were trained in the use of OCA either in a standardized group session or individually, based on their availability to attend the group session. Physicians completed a data collection form that included wound characteristics, type of instruction, and number of lacerations previously repaired with OCA. Impressions of time required, difficulty, and postrepair cosmesis were each recorded on a 5-point Likert scale. The 3 scales were totaled to yield a 15-point summary outcome measure. Univariate nonparametric comparisons of measures were performed between physicians with and without group instruction and between those with and without prior OCA experience. Using 35 subjects in each group, this study had a power of 0.95 to detect a difference of 1.5 points in the 15-point summary score, using alpha = 0.05. RESULTS: Eighty-one subjects were enrolled; the median summary score was 13 (IQR 12 to 15). There was no statistically significant difference in the summary score, nor any of its 3 components (time saved, difficulty, cosmesis), when comparing physicians with and without group instruction, nor when comparing first-time users to those with prior experience. CONCLUSION: OCA application is an easily acquired skill. Physicians were satisfied with their proficiency in OCA application, regardless of type of instruction received or number of previous lacerations repaired with OCA.

Academic Medical Centers↗
PubMed1997

Experiences in deployment of a Web-based CIS for referring physicians.

Improving the timeliness and efficiency of information exchange between the hospital and clinicians in the health care community is an area of active interest at the Massachusetts General Hospital (MGH). Providing computer-based access to referring physicians who are not formally affiliated with the hospital is a particular challenge since these offices are not connected to the hospital network and lack the standard hospital workstation hardware and software. Installing clients for the hospital's clinical applications at these sites has been a difficult and costly proposition. The emergence of Web technology yields an alternative method for developing clinical applications for this remote, diverse user population. We present our experiences during the first six months of deployment of a Web-based clinical information system designed for use by referring physicians.

Computer Communication Networks↗
PubMed1991

The characteristics of cocaine users among young adults in Sydney.

OBJECTIVE: To describe the prevalence and pattern of cocaine use among young Sydney adults interviewed during a study of the "market position" of cocaine. DESIGN: A telephone survey of young Sydney adults. PARTICIPANTS: A total of 499 young Sydney men and women aged between 14 and 35 were selected to ensure a sample of 300 persons who used alcohol and tobacco at least weekly, and who had been offered or had tried at least one illicit drug. MAIN OUTCOME MEASURES: These were the prevalence of having ever used cocaine, the frequency of cocaine use, the prevalence of daily alcohol and tobacco use, and of ever having tried marijuana, sedatives, designer drugs, amphetamines and heroin. RESULTS: Thirteen per cent of the sample (95% confidence interval [CI], 10%-16%) had ever tried cocaine, of whom only 20% (CI, 15%-25%) were current users. Cocaine users were distinguished from non-users by being more likely to be daily users of tobacco (odds ratio, 2.1; CI, 1.3-3.6) and alcohol (odds ratio, 3.0; CI, 1.7-5.6), and to have tried marijuana (odds ratio, 7.1; CI, 3.2-15.9), sedatives (odds ratio, 11.4; CI, 6.4-20.7), designer drugs (odds ratio, 17.2; CI, 9.2-32.2), amphetamines (odds ratio, 27.1; CI, 14.3-51.3), and heroin (odds ratio, 36.5; CI, 14.0-94.9). The odds of having tried cocaine increased with the number of different types of illicit drugs that the person had tried. CONCLUSIONS: The prevalence of ever having tried cocaine was low among a sample of young adults selected to ensure an over-representation of illicit drug users. Cocaine users were more likely to have experimented with a variety of different types of illicit drugs. Only a minority of those who had ever tried cocaine were current users.

Adolescent↗
PubMed2001

Cocaine use is an independent risk factor for cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Although acute cocaine use has been temporally associated with aneurysmal subarachnoid hemorrhage (aSAH), the prevalence of vasospasm and the clinical outcome of patients experiencing aSAH associated with cocaine exposure are unclear. We have analyzed this patient population in our institution to address these issues. METHODS: Between 1992 and 1999, 440 patients presented to our institution with aSAH. This sample was retrospectively analyzed to determine which patients had used cocaine within 72 hours of aSAH as documented by urine toxicology studies or patient history. These patients were then compared with control aSAH patients without recent cocaine exposure through univariable and multivariable analyses. RESULTS: Twenty-seven aSAH patients (6.1% of total) had either urine toxicology positive for cocaine metabolites (20 patients, 74%) or a history of cocaine use within 72 hours of aSAH (7 patients, 26%). Cocaine users were more likely to experience cerebral vasospasm defined as a delayed clinical deficit (from 3 to 16 days after aSAH) unexplained by concurrent CT scan and either responsive to hypervolemic and/or hypertensive therapy or accompanied by angiographic confirmation of vessel narrowing than control subjects (63% versus 30%; odds ratio [OR], 3.90; 95% confidence interval [CI], 1.77 to 8.62; P=0.001). Patients using cocaine were younger than control subjects (mean age, 36 versus 52 years; P<0.0001). Aneurysms of the anterior circulation were observed more frequently in cocaine users than in control subjects (97% versus 84%; OR, 6.89; 95% CI, 1.18 to 47.47; P=0.029). A significant difference was not observed, however, in the discharge Glasgow Outcome Scale (GOS) scores between the 2 groups (P=0.73). Differences were not observed between the 2 groups when the distributions of sex, hypertension, admission Glasgow Coma Scale subarachnoid hemorrhage grade, and multiple aneurysms were analyzed. Logistic regression models identified variables independently associated with vasospasm and discharge GOS score. Only a thick blood clot on the admission CT (OR, 7.46; 95% CI, 3.95 to 14.08; P<0.0001) and recent cocaine use (OR, 6.41; 95% CI, 2.14 to 19.23; P=0.0009) were independently associated with vasospasm. Cocaine use was not independently associated with the discharge GOS score. CONCLUSIONS: We conclude that there is an increased prevalence of vasospasm in aSAH patients with recent cocaine exposure but no difference in clinical outcome. In addition, these patients are younger and more likely to have anterior circulation aneurysms.

Adult↗
PubMed2005

The rise of club drugs in a heroin society: the case of Hong Kong.

Although the contemporary dance drug scene is a global phenomenon, with many countries and cultures reporting similar developments with ecstasy and other club drug use, the scene, in many respects, is a reflection and expression of local culture. This article examines the rise of the dance drug scene in a society long associated with opiate use. After briefly describing Hong Kong's drug history, this article describes the diversification of its drug market to include ecstasy and ketamine in the context of a distinctive dance setting. The paper examines the trends in club drug use, particularly with the emergence of the dance scene, motivations to use, types of users, and the problems they experience with club drugs. The paper discusses the reasons for the rise and popularity of club drugs in the context of other locally available drugs, in particular, heroin. This discussion draws from three studies that tracked drug use trends from 1995 to 2002 through a variety of data sources, including official statistics, field observations, individual interviews with 20 law enforcement officials, 16 focus groups with outreach and drug treatment workers, teachers, and representatives from different communities, and in-depth interviews with 27 club drug users.

Adult↗
PubMed1999

Women's satisfaction with birth control: a population survey of physical and psychological effects of oral contraceptives, intrauterine devices, condoms, natural family planning, and sterilization among 1466 women.

User satisfaction and the physical and psychological effects of five commonly used contraceptive methods were investigated in a population survey among 1466 West German women. The focus was on effects attributed by current and past users to these methods, rather than objectively assessed effects, to shed further light on personal experiences that are highly relevant to the user but often remain unknown to prescribers and unreported in the medical literature. Within the overall sample, 1303 women were surveyed concerning their current or past use of oral contraceptives (OC), 996 regarding condoms, 342 with respect to intrauterine devices (IUD), 428 in regard to natural family planning (NFP), and 139 in relation to sterilization (respondents completed questions about each method used). It emerged that satisfaction was greatest with sterilization (92% of users), followed by OC (68% of ever users), IUD (59%), NFP (43%), and condoms (30%). Almost one in three NFP users had experienced an unwanted pregnancy during use of this method, as compared with one in 20 OC and condom users. The majority of users reported no mood changes during use of the methods studied. The percentages reporting negative mood changes (various items were scored) were up to 16% among OC users, 23% among condom users, and 30% among NFP users. The latter observations suggested that subjective side effects of a contraceptive agent on mood generally reflected, at least in part, the user's sense of confidence in the method concerned (notably, with regard to efficacy and safety). Oral contraceptives, IUD, and sterilization had a broadly positive impact on sex life, whereas that of condoms was often negative. Whereas OC users often reported less heavy and painful menstruation (in up to 56% of cases), IUD were associated with heavier, prolonged, and more painful menstruation (in up to 65% of cases), as also was sterilization, although to a lesser extent (in up to 32% of cases). Overall, the study findings indicated that OC and sterilization had less negative impact on physical and psychological functioning than the other methods studied, in contrast to what the general public often believes.

Adult↗
PubMed2002

Ministry of Health user fees, equity and decentralization: lessons from Honduras.

Decentralization is commonly championed as a means for achieving equity. To date, however, there has been little discussion of the mechanisms underlying this relationship, and several of the few empirical investigations that have addressed the topic have found the converse; that decentralization has exacerbated inequalities. This article examines the performance and equity in financing of the Honduras Ministry of Health's (MOH) decentralized user fee system. The MOH of Honduras established a national user fee policy in 1989. It provided a framework of rules and regulations and decentralized administration of the system to the regional offices. A survey conducted under the auspices of this study provided detailed information about the structures and operations of MOH user fee systems. The survey revealed that the systems vary markedly by region, creating horizontal inequities, and that they have numerous other shortcomings. The average price of a consultation is low, US dollars 0.16, and revenues have consistently equalled just 2% of MOH expenditures. The systems' administrative costs are equal to 67% of their revenues. Eliminating the user fee systems in all but the national and regional hospitals would actually save money and/or enable the MOH to provide more care. Average consultation prices are highest in health posts, intermediate in centres and lowest in the national hospitals, thereby encouraging the inappropriate use of the MOH's pyramidal referral system and fostering MOH inefficiency. Fee levels and exemption practices are horizontally and vertically inequitable. The likelihood of paying for an ambulatory visit is highest at a health post, 89%, and lowest at a hospital, 49%. Individuals from the poorest one-fifth of households are the most likely to have to pay for care. Honduras' experience demonstrates that a decentralized user fee system is not necessarily equitable, and that, more generally, the gains that can be realized from decentralizing user fee systems are not automatic. They must be anticipated, planned for and cultivated by a well-designed and well-implemented initiative that is not a single, one-time event, but rather a dynamic, on-going enterprise.

Ambulatory Care Facilities↗