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PubMed2003

COMPARE radiology: creating an interactive Web-based training program for radiology with multimedia authoring software.

RATIONALE AND OBJECTIVES: Computer-based training has two primary benefits: Content can be presented interactively, and students can choose the time, place, and pace of learning. As a subject of medical education, radiology lends itself particularly well to computer-based training because of its highly visual content. To improve the efficiency of radiology training at their institution, the authors decided to create an interactive Web-based training site. MATERIALS AND METHODS: Working with a group of medical students knowledgeable in multimedia authoring, the authors used authoring software to create "COMPARE Radiology," an interactive training program that follows the modality-based structure of the undergraduate curriculum for radiology at the University of Erlangen-Nuremberg, Erlangen, Germany, and at medical schools worldwide. RESULTS: The Web-based program offers cases and exercises in radiographic anatomy at different selectable levels of difficulty, allowing users to test and build their knowledge of radiology. Pathologic images are initially presented without any further information. Additional information (patient history, laboratory results, reports from other imaging studies, and normal images for comparison) can be retrieved selectively and successively. Further information regarding the diagnosis and pathologic findings can be found by following links to external Web sites. The COMPARE Radiology program content is extended and updated regularly. The program is subject to internal peer review and can be evaluated by the user online. CONCLUSION: The authors' experience shows that a highly interactive Web-based training program for radiology, tailored to the requirements of the target group, can be developed economically by a team of medical students using an advanced storing system, with the guidance of a radiologist and without the help of professionally trained computer experts.

Computer-Assisted Instruction↗

PubMed1989

Experience with portable ultrasound equipment and measurement of urine volumes: inter-user reliability and factors of patient position.

A portable ultrasound unit has been developed that provides a noninvasive technique to measure urine volume. We assessed the effect of patient position on the accuracy of measurements as well as inter-user reliability and user training. There were 63 ultrasound measurements of urine volume made by a trained and an inexperienced examiner, and the values were compared to true volumes obtained by catheterization in 16 adults with a neurogenic bladder. Subjects were tested in the seated and supine positions. Correlation for ultrasound volumes between the trained and inexperienced examiners was highly significant. Accuracy and precision of the ultrasound measurements were not affected by patient position. Thus, little training is necessary to use this instrument, inter-user reliability is good, and accuracy and precision are clinically acceptable whether patients are in the seated or supine positions.

Adult↗

PubMed2002

Getting to the truth? Researching user views of primary health care.

In countries at all levels of development, assessing the opinions of health service users is increasingly promoted as an integral part of quality evaluations. However, there has been much debate on how best to measure user opinions. This article discusses findings from a study in South Africa, which employed both closed-ended facility exit interviews (total 337) and open-ended community-based focus group discussions (total 14) to obtain users' views on the same set of primary care providers. We outline various difficulties encountered in the interpretation of the data. First, in the absence of explicit and universal standards, users evaluated providers against their experiences with other health care services available to them in their areas. Responses were thus highly context specific, dependent on the particular configuration of services in each site. Secondly, the focus group discussions provided a very different (generally more negative) picture of providers to the exit interviews, suggesting that where and how views of health services are elicited has a large bearing on the results obtained. Thirdly, the focus group discussions appeared to encourage dramatic representations of what was, on observation, a banal everyday reality. Both methods defied superficial reading, and each appeared to have limitations in establishing the 'truth' about people's opinions. We conclude that there is a need for greater recognition, in quality assessments and in quality assurance, that user and community opinion is a social rather than a technical phenomenon. As such it is dynamic, bound to particular contexts and difficult to capture in single, 'snap-shot' assessments, no matter how well designed. In the context of quality assurance programmes, time spent assessing user views may be better used in other ways such as training and supporting health care workers to engage directly in dialogue with communities around needs and expectations.

Consumer Behavior↗

PubMed2004

PARIS: a proteomic analysis and resources indexation system.

UNLABELLED: We developed a system for managing data from two-dimensional electrophoresis-based proteomic experiments. Named PARIS, the system stores gel image and information about experiments and analysis procedures, allows the user to search and navigate in genomic and proteomic data, supports visual verification and validation of the analysis results, and provides tools for cross multi-experiment and multi-experimenter data validation and exploration. AVAILABILITY: The software is freely available from http://www.inra.fr/bia/J/imaste/Projets/PARIS/index.html

Abstracting and Indexing↗

PubMed2001

Early clinical manifestations of cannabis dependence in a community sample.

BACKGROUND: In this research, the 'natural history' of cannabis dependence is probed, using data from a large epidemiological sample of cannabis users followed from 1981 through 1996, until most of these users had passed through the empirically derived period of risk for developing cannabis dependence. METHODS: The Baltimore Epidemiologic Catchment Area research group sampled, recruited, and assessed 3481 adults age 18+ years in 1981. Survivors were re-assessed roughly 13 years later. Among 599 cannabis users, a total of 37 had become cases of cannabis dependence during the follow-up interval; 41 had developed DSM-IIIR cannabis abuse without dependence; 521 had suffered insufficient problems to qualify as cases. Survival analysis methods were used to plot and study the cumulative occurrence of these problems in a primary contrast of the 37 dependence cases and 562 non-cases. RESULTS: Subjectively felt loss of control over cannabis and continued cannabis use despite knowledge of harm seem to appear most rapidly among cases of cannabis dependence. In contrast, subjectively felt withdrawal symptoms tended to emerge later and for a much smaller proportion of dependence cases and non-cases. CONCLUSION: The 5000+ person-years of follow-up experience provided by the cannabis users in this study give an unprecedented look at the natural history and clinical course of cannabis dependence. Distinctive features of early cannabis dependence may help differentiate cannabis users who progress to clinically significant dependence from those who remain non-dependent.

Adolescent↗

PubMed1998

Study of user preference of graphic user interface in laboratory information system.

In order to elucidate employees satisfaction levels in using graphic user interface. (GUI) in a laboratory information system (LIS), users attitudes toward GUI versus CUI. (Character User Interface) in a similar LIS were surveyed one month after implementing upgraded version of LIS in a tertiary care university hospital laboratory. The outcome of the study showed that approximately two third of users preferred to have GUI in LIS. There was no difference in preference of GUI of users whether they had previous experience with GUI or not. However the female and older employees tend to shy away from GUI. The employee productivity was improved with GUI although it takes slightly longer program loading time than that of CUI. In conclusion, the laboratory employee satisfaction was higher with GUI than CUI and their productivity was improved with GUI.

Adult↗

PubMed2003

Virtual reality and interactive 3D as effective tools for medical training.

CAVE-like displays allow a user to walk in to a virtual environment, and use natural movement to change the viewpoint of virtual objects which they can manipulate with a hand held device. This maps well to many surgical procedures offering strong potential for training and planning. These devices may be networked together allowing geographically remote users to share the interactive experience. This maps to the strong need for distance training and planning of surgeons. Our paper shows how the properties of a CAVE-Like facility can be maximised in order to provide an ideal environment for medical training. The implementation of a large 3D-eye is described. The resulting application is that of an eye that can be manipulated and examined by trainee medics under the guidance of a medical expert. The progression and effects of different ailments can be illustrated and corrective procedures, demonstrated.

Computer Simulation↗

PubMedDate not supplied

CORBA security services for health information systems.

The structure of healthcare systems in developed countries is changing to 'shared care', enforced by economic constraints and caused by a change in the basic conditions of care. That development results in co-operative health information systems across the boundaries of organisational, technological, and policy domains. Increasingly, these distributed and, as far as their domains are concerned, heterogeneous systems are based on middleware approaches, such as CORBA. Regarding the sensitivity of personal and medical data, such open, distributed, and heterogeneous health information systems require a high level of data protection and data security, both with respect to patient information and with respect to users. This paper, relying on experience gained through our activities in CORBAmed, describes the possibilities the CORBA middleware provides to achieve application and communication security. On the background of the overall CORBA architecture, it outlines the different security services previewed in the adopted CORBA specifications which are discussed in the context of the security requirements of healthcare information systems. Security services required in the healthcare domain but not available at the moment are mentioned. A solution is proposed, which on the one hand allows to make use of the available CORBA security services and additional ones, on the other hand remains open to other middleware approaches, such as DHE or HL7.

Computer Communication Networks↗

PubMed2006

"User involvement is a sine qua non, almost, in medical education": learning with rather than just about health and social care service users.

Despite the General Medical Council emphasising the value of service users to medical students' education, there is scant literature about service user involvement in medical education. Although some research has outlined the effectiveness of service users as teachers, none has explored social issues surrounding how medical students learn 'with' rather than just 'about' service users. Incorporating insights from contemporary socio-cultural learning theory, this study examines the views and experiences of 47 stakeholders (comprising 19 service users, 13 medical students and 15 medical educators) concerning service user involvement in medical education. Eight audiotaped focus group discussions were convened and the audiotapes were transcribed. The transcripts and audiotapes were independently analysed by multiple researchers using Framework analysis. Seven content- and five process-orientated themes emerged from the analysis. Content-related themes included the costs and benefits of service user involvement in medical education and process-related themes included the use and function of humour and metaphor. In this paper, we focus primarily on the content-related themes. We discuss these findings in light of the existing service user involvement literature and contemporary socio-cultural learning theory and provide implications for further research and educational practice. We encourage educators to involve service users in medical education but only in a considered way.

Adult↗

PubMed2004

Feedback from community pharmacy users on the contribution of community pharmacy to improving the public's health: a systematic review of the peer reviewed and non-peer reviewed literature 1990-2002.

OBJECTIVE: To systematically review feedback from pharmacy users on their perceptions and experiences of health-related advice and services provided from community pharmacies. METHODS: The focus of the review was community pharmacy activities in relation to promoting health and well-being, preventing ill-health and maintaining health. Searches were conducted for peer-reviewed (international) and non-peer-reviewed (UK) research. Electronic databases searched included MEDLINE, EMBASE, Cochrane Library and International Pharmaceutical Abstracts; hand searches of key journals and conference abstracts, key informants. Key informants in the UK were contacted to identify unpublished studies. The inclusion period was 1990 onwards. Data extraction and synthesis Data were abstracted into a matrix by one author with a sample checked by a second. The Health Development Agency's Evidence Base 2000 standards and the evidence categories used by the Department of Health in the National Service Frameworks were applied to each item. MAIN RESULTS: Seven peer reviewed papers and 13 non-peer reviewed reports were identified for inclusion in the review. Consumer usage of pharmacies is almost universal with prescription supplies and purchase of over the counter medicines predominating. Evidence shows that not only is usage low for general health advice, but that pharmacists are perceived as 'drugs experts' rather than experts on health and illness. Emergency hormonal contraception and head lice management schemes have been well received. There is a need to consider privacy and confidentiality surrounding advice giving. CONCLUSIONS: Users of community pharmacy-based health development initiatives express a high level of satisfaction. If community pharmacies are to be used to their full extent, then actions to extending the public's awareness and acceptance of the pharmacist's role in giving advice will be crucial. Further research will be needed to measure any change in premises development on the public's perception of the level of privacy in pharmacies.

Confidentiality↗

PubMed1996

Management of hormone replacement therapy: the Italian experience.

OBJECTIVES: To review the characteristics of users and prescribers of hormone replacement therapy (HRT) in Italy, to attempt to explain the low uptake of this therapy. METHODS: A review of the published literature and prescription data. RESULTS: As in many other Western countries, gynaecologists are the main prescribers of HRT in terms of the number of prescriptions/physician/year. However, because general practitioners renew specialists' prescriptions several times a year, they are responsible for the greatest prescription volume. Overall GPs are responsible for 77.6% of HRT prescriptions while gynaecologists account for 20.7%. The attitude of gynaecologists and GPs to HRT is still equivocal and this may be a major factor in the low uptake. The percentage uptake is higher in northern and central Italy than in the south and it has been suggested that women in the hotter southern areas may suffer less from hot flushes. The evidence for this, however, is anecdotal. A recent study in Milan showed that the use of HRT was strongly correlated to social class and level of education. Women with 12 years of education or more were three times more likely to use HRT than those with less than 7 years education. There seemed to be no relationship between marital status and HRT use but fewer parous women used it and use decreased with an increasing number of children. In addition postmenopausal osteoporosis is not yet a registered indication for transdermal HRT, the major route of HRT administration in Italy. CONCLUSIONS: An increased uptake is expected in the future due to increased media interest and the greater availability and steady increase of transdermal HRT use over the last 5 years.

Climacteric↗

PubMed2006

Issues of informed consent for intrapartum trials: a suggested consent pathway from the experience of the Release trial [ISRCTN13204258].

Service users within the NHS are increasingly being asked to participate in clinical research. In Liverpool Women's NHS Foundation Trust, approximately 35% of women take part in research during their pregnancy. For many studies the consent process is simple; information is provided and signed consent is given. There is a difficulty, however, with obtaining informed consent from women in pregnancy who become eligible only when they develop unforeseen complications, especially when they occur acutely. The problem is compounded with women in labour who may be frightened, vulnerable, in pain, under the effect of opiate analgesia, or all of the above. If research to improve the care of these women is to continue, then special consent procedures are needed. These procedures must ensure that the woman's autonomy is protected whilst recognising that women under these circumstances vary enormously, both in their desire for information and their ability to comprehend it. This paper will discuss the obtaining of consent in this situation, and describe an information and consent pathway for intrapartum research which has been developed in collaboration with consumer groups as a way in which these issues can be tackled.

Editorial↗

PubMed1996

Eyeglass MEDRETE: practical considerations (a user's guide).

This article presents the experiences of two independent practitioners who participated in eyeglass-dispensing medical readiness training exercises (MEDRETEs) in Central America. It explains the importance of defining personnel policies, having the proper equipment, utilizing the retinoscopists optimally, and having an adequate supply of eyeglasses with plus lens power for indigenous persons in this geographic area. To maximize the effectiveness of a MEDRETE, a dispensing optician and two teams of translators are needed. Triage of patients will permit the optimal number of refractions and distribution of corrective lenses to those most in need. Fitting indigenous patients with corrective lenses in one of the more tangible and lasting effects of a MEDRETE. It contributes not only to patient satisfaction but possibly to improved relationships with the host nation.

Central America↗

PubMed1999

EMAN: semiautomated software for high-resolution single-particle reconstructions.

We present EMAN (Electron Micrograph ANalysis), a software package for performing semiautomated single-particle reconstructions from transmission electron micrographs. The goal of this project is to provide software capable of performing single-particle reconstructions beyond 10 A as such high-resolution data become available. A complete single-particle reconstruction algorithm is implemented. Options are available to generate an initial model for particles with no symmetry, a single axis of rotational symmetry, or icosahedral symmetry. Model refinement is an iterative process, which utilizes classification by model-based projection matching. CTF (contrast transfer function) parameters are determined using a new paradigm in which data from multiple micrographs are fit simultaneously. Amplitude and phase CTF correction is then performed automatically as part of the refinement loop. A graphical user interface is provided, so even those with little image processing experience will be able to begin performing reconstructions. Advanced users can directly use the lower level shell commands and even expand the package utilizing EMAN's extensive image-processing library. The package was written from scratch in C++ and is provided free of charge on our Web site. We present an overview of the package as well as several conformance tests with simulated data.

Algorithms↗

PubMed2001

"War stories": AIDS prevention and the street narratives of drug users.

The day-to-day discourse of illicit drug users is replete with stylized narratives of street experience. These "war stories," as they are popularly known, are shared among drug users as they hustle for money, purchase drugs, get high, and hang out in diverse street locations. Drug-user narratives, which describe complex adventures and grave suffering, are primary ethnographic sources of information about patterns of drug consumption and risk behaviors. Importantly, in the time of AIDS, street narratives provide a much-needed window on the generally hidden lives of socially marginalized street drug users. As part of an effort to put the analysis of drug-user war stories to use in HIV prevention, in this article the authors analyze a corpus of street narratives told to members of an HIV-prevention research team in Hartford, Connecticut.

Adaptation, Psychological↗

PubMed2004

Harm-reduction activism: a case study of an unsanctioned user-run safe injection site.

Due to the ongoing health crisis among injection drug users in Vancouver, Canada, there have been repeated calls for the establishment of safe injection sites (SISs) since the early 1990s. In April 2003, in response to a large-scale police crackdown and government inaction, a group of activists opened an unsanctioned SIS in Vancouver's Downtown Eastside (DTES). The 327 Carrall Street SIS operated for 181 days despite considerable police harassment and limited financial support. During the operation of the SIS, volunteers supervised over 3000 injections and demonstrated the feasibility of a user-run low-threshold SIS. The experience of the SIS provides valuable lessons for those seeking to advance the interests of injection drug users through community mobilization and direct action approaches. In this article, Thomas Kerr, Megan Oleson, and Evan Wood describe the events surrounding the establishment, operation, and closing of the unsanctioned SIS, and outline the lessons learned.

British Columbia↗

PubMed2006

Providing an internet-based audiological counselling programme to new hearing aid users: a qualitative study.

People with an acquired hearing loss often have difficulty adjusting to a first hearing aid. Studies have shown that audiological counselling can facilitate adjustment to a first hearing aid. Because of its interactive nature, the internet could be a valuable tool to gain information about the experiences of the new hearing aid user and to address the needs for audiological counselling. An internet-based audiological counselling programme in the form of daily e-mails during the first month after the hearing aid fitting was offered to three new hearing aid users. The data, qualitative in nature, were comprised of the content of the e-mails and of in-depth interviews with the participants and their audiologist, and were analysed according to grounded theory. Overall, the internet-based audiological counselling programme provided rich descriptions of the experiences of the participants and reinforced positive adjustment behaviours experienced by them.

Aged↗

PubMed2001

Application of virtual microscopy in clinical cytopathology.

Virtual microscopy (VM) refers to the use of an automated microscope and digital imaging technology to scan, store, and view glass slides. VM systems allow the user to view a scanned image of the entire slide at multiple magnifications on a computer screen. We tested VM to evaluate its possible utility in diagnostic cytopathology. Ten cervical-vaginal monolayered preparations (AutoCyte preparation) were scanned using a BLISS (Bacus Laboratories Inc. Slide Scanner) system. Approximately 20-30% of the cellular area of each slide was imaged. The cases were randomly chosen to include examples ranging from benign cellular changes (BCC) to high-grade squamous intraepithelial lesions (HSIL). The computer performed image tiling and fusing of multiple JPEG images to create a high-quality VM slide. Six examiners (two each of cytopathologists, senior residents, and cytotechnologists) blindly evaluated the VM slides using an image server program (WebSlide Browser thin client software). The cytopathologic diagnoses made on the VM slide were then compared to the original glass slide diagnoses. BLISS took 36-100 min (avg. 58.4 min) to scan the selected fields in a glass slide with file sizes ranging from 23.1-83.6 MB. Time taken by the examiners to render a diagnosis ranged from 1-15 min (avg. 4.1 min) per case. The combined diagnostic accuracy was 98.3%. Only one case of LSIL was missed by one examiner. VM is a promising new tool, which gives a user the feel and simulated experience of an actual microscopic examination and provides a useful alternative to a glass slide in diagnostic cytopathology. Possible applications include: 1) second opinion consultation without transporting the glass slide, 2) education, 3) VM proficiency tests / board exams, and 4) telepathology. Shortcomings include 1) expensive initial setup, 2) inability to maintain an adequate focus in a thick smear with multiple levels, 3) large storage size of the VM slide, and 4) relatively long time needed to scan a slide.

Female↗