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Treating first episode psychosis--the service users' perspective: a focus group evaluation.

UK national guidance has prioritized developing specialist services for first episode psychosis. Such services are in the early stages of development and a definitive treatment model has yet to be established. The aim of this study was to explore service users' experiences of a first episode intervention designed along evidence-based 'best practice' guidelines and to establish specific elements seen as effective to help inform future service planning and provision. Twelve users of a specialist first episode service participated in focus groups. These were then analyzed using Interpretative Phenomenological Analysis, a specialized form of content analysis. Key elements identified by the service users included the 'human' approach as a key to the recovery process, being involved in treatment decisions, flexibility of appointments, high nurse to patient ratio, reduction in psychotic symptoms, increased confidence and independence and the provision of daily structure. To our knowledge, this is the first systematic qualitative evaluation of users' experience of a specialist first episode treatment intervention. Our findings indicate that adherence to best practice guidelines was appreciated. Regular focus groups provide a continuous audit cycle incorporating service improvements in line with government recommendations, centrally informed by the service users' and caregivers' perspective.

Adult↗

Associations between smart infusion pump-electronic health record interoperability and healthcare outcomes: A systematic review.

OBJECTIVE: This study synthesized available evidence on the associations between smart infusion pump-electronic health record (EHR) interoperability and healthcare outcomes. METHODS: A systematic review of PubMed, CINAHL, Embase, and Scopus databases identified 901 records, which were imported into Rayyan® for duplicate removal, independent screening by three reviewers, and resolution of discrepancies. Eligible studies were peer-reviewed, data-driven, and reported associations between smart infusion pump-EHR interoperability and healthcare outcomes. Studies focused solely on technical validation or interoperability prototypes were excluded. A backward citation search identified additional studies. Two reviewers independently extracted and cross-validated study characteristics using standardized templates. Methodological quality was assessed with the Joanna Briggs Institute Critical Appraisal Tools. RESULTS: Twenty records of 14 full-text studies and 6 conference proceedings were included. Most records reported positive associations between smart infusion pump-EHR interoperability and outcomes related to safety (e.g., medication administration errors, safety-reported events, pump alerts, and compliance with interoperability and drug library), operational efficiency (e.g., programming and documentation time and technical issues), financial performance (e.g., charges captured, and cost avoided), and user experience domains. Most studies used observational designs, reflecting real-world interoperability implementations, where controlling confounding factors is challenging. Limited reporting of baseline characteristics, pump type, and sample sizes limited comparability across studies. CONCLUSIONS: Smart infusion pump-EHR interoperability was associated with improvements in patient safety, efficiency, charge capture, and user experience, with variable findings across studies. Future research should use rigorous methodologies and standardized measures, examine relationships across outcome domains, assess limitations of pump-EHR interoperability, and evaluate underexplored outcomes, including team communication, cognitive workload, and AI-enabled pumps. IMPLICATIONS FOR CLINICAL PRACTICE: Interoperability should be viewed as a component of a broader sociotechnical system, in which technology, user, workflow, clinical content, and organizational practices collectively determine overall effectiveness.

Humans↗

Using apprenticeship communication flow as an ergonomic design input for future OR systems.

Removing the gallbladder is a relatively simple laparoscopic operation. Tissue trauma, caused by laparoscopic cholecystectomy, is usually minimal. Misidentifying the cystic duct and artery and the common hepatic duct represents the most severe complication. However, the Critical View of Safety (CVS) technique reduces the risk of trauma, by accomplishing a safe 360 degrees identification of the cystic duct origin at the gallbladder neck [ 5 ]. This technique is employed and trained at the Erasmus Medical Centre (EMC), Rotterdam, The Netherlands. This study presents the potential value of a training device which residents can use during practice. This training device must cover both user friendliness and information supply. The current information supply was studied subjectively; the CVS protocol and the users' experience were studied both objectively and subjectively. The results of these studies show that the present information supply is not satisfactory, that there is a CVS protocol which can be easily used in a training device, and that most actions defining the cystic duct during operation revert on users' experience. Therefore, it is desirable to design a new training device according to the experience of the target group and the protocols, and taking into account an optimal human-product interaction.

Journal Article↗

Case study: factors in defining the nurse informatics specialist role.

Healthcare organizations, consultant groups, vendor companies, and academic institutions feel the challenge to enhance user experiences with information systems. To meet this challenge, organizations and companies are looking to better understand and utilize a variety of informatics roles to further marketing, business, or healthcare goals. Nursing is one practice area that can support the successful integration of information systems development, implementation, support, and user experience. However, the definition and development of such a role or position has met with mixed success. This article explores some of the issues and influences related to the role's development. The issues, impacts, and influences have been identified based on healthcare business assessment, job description analysis, employment and project evaluations, and professional standards set by the American Nurses Association.

Humans↗

A user's experience with a standard non-linear regression program (BMDP3R).

A study was made to test and compare the behavior of a standard non-linear regression program (BMDP3R) in fitting data from six classical least-squares problems. The use of three program control parameters is discussed and four measures of regression failure are utilized to give a quantitative reference of success. Recommendations are given to aid the user of packaged programs in the parameter estimation of non-linear regression models.

Computers↗

The PHILSOM system--one user's experience.

The University of Texas Health Science Center at San Antonio joined the PHILSOM system, a comprehensive serials control network, in 1971. The experiences of the library in using the system are described. The major benefit of the system has been multiple copies of the holdings list which have made the serial records publicly accessible and significantly increased their value. Tallies of these lists' use indicate that more than half of serials-related questions are now answered directly by the users. The effects of PHILSOM on the procedures of the serials department--processing, claiming, bindery, and personnel are described. Costs to the network and the UTHSCSA Library are briefly summarized.

Catalogs, Library↗

Supplying emergency contraception via community pharmacies in the UK: reflections on the experiences of users and providers.

This paper discusses findings from an evaluation of a scheme to provide free emergency hormonal contraception (EHC) via community pharmacies in the North-West of England. Drawing on interview data with pharmacists taking part in the scheme and focus groups with users, we tentatively suggest that the scheme was largely well received. The benefits of the service, cited by both pharmacists and users, included enhanced access to EHC, at times when it was needed, and at no cost to the user. In particular, users noted a welcome absence of judgmental attitudes when accessing the service. Pharmacists too were positive about the service, not least because they believed that it conferred enhanced professional status. However, both users and pharmacists had a number of major concerns about the schemes, centring on the potential for misuse, changes in contraceptive behaviour and the impact on sexually transmitted infections. We conclude that more research is needed to explore these issues.

Adult↗

HIV testing experience of drug users in Bali, Indonesia.

Recently, large increases have been noted in injection drug use and HIV prevalence among drug users in Indonesia. The objective of this study was to examine the experience of drug users with HIV testing in Bali, Indonesia. In-depth interviews were conducted with a sample of 40 drug users who had injected heroin in the Denpasar, Bali area. The users' experience with testing highlighted the importance of pre- and post-test counselling that provides clear information, confidentiality and assistance in developing social support.

Adolescent↗

[The diaphragm as a contraceptive method in the experience of users in the public health services]

This study, started in August 1989, describes the acceptability of diaphragms as part of the daily routine of 194 women enrolled at five public health care centers in Osasco, (Greater São Paulo). Follow-up of the cohort was performed by semestral home interviews until August 1991. Our data indicate that the diaphragm can be a viable alternative within the public health care setting. Women, including those from low-income groups, are interested in new alternatives to currently available contraceptive practices. Nevertheless, the cumulative rate of continuity for use of the method was only 25.7% (39 women) after a period of 12 months. Only 37.1% of women opting for the diaphragm confirm its use during every act of sexual intercourse. Most of the women (72.7%) only learned about diaphragms during the process of choosing a contraceptive method. The main reasons for discontinued use were partners' complaints, discomfort, and difficulty in handling. The findings point to the need for reformulating family planning activities to provide greater support for women, introduce initiatives to enhance male participation, and promote on-going training of health professionals with regard to the management of the method and support for its users.

Journal Article↗

Pneumobelt for sleep in the ventilator user: clinical experience.

A pneumobelt with a positive pressure respirator was used for sleep for three patients with chronic respiratory insufficiency secondary to syringomyelia, poliomyelitis, and Friedreich's ataxia respectively. This device was found to be effective in improving and maintaining their daily functioning in the community or institute.

Chronic Disease↗

A 'bittersweet pill to swallow': learning from mental health service users' responses to compulsory community care in England.

Two forms of compulsory mental healthcare and supervision in the community are provided within the Mental Health Act 1983: Supervised Discharge Orders (SDOs) and guardianship. At a time when the Government are proposing to extend powers of supervision over people with severe mental illness in the community, it is appropriate that service users' experiences of existing legislation are examined and reported. Despite a range of literature that presents mental health service users' views and experiences, it remains unclear how service users respond to compulsory community mental healthcare in England. The present paper presents the findings of a qualitative investigation into service users' perceptions and experiences of living with SDOs. In the interviews, service users communicated their understanding of why mental health professionals placed them on the order and how their lives have been affected. Individual service users are capable of seemingly contradictory responses, simultaneously accepting and resisting the orders. This paper presents a typology of the range of responses. These responses are fatalism and resignation, dependency, ownership, bargaining, cooperation, resistance, and rejection. The study provides a model with which we can begin to understand how service users respond to compulsory community care where their options are legally constrained.

Adult↗

Mobile phone use and subjective symptoms. Comparison of symptoms experienced by users of analogue and digital mobile phones.

In 1995 many people reported symptoms such as headaches, feelings of discomfort, warmth behind/around or on the ear and difficulties concentrating while using mobile phones. The number of complaints was higher for people using the digital (GSM) system, i.e. with pulse modulated fields, than for those using the analogue (NMT) system. Our main hypothesis was that GSM users experience more symptoms than NMT users. An epidemiological investigation was initiated including 6379 GSM users and 5613 NMT 900 users in Sweden, and 2500 from each category in Norway. The adjusted odds ratio did not indicate any increased risk for symptoms for GSM users compared with NMT 900 users. Our hypothesis was therefore disproved. However, we observed a statistically significant lower risk for sensations of warmth on the ear for GSM users compared with NMT 900 users. The same trend was seen in Norway for sensations of warmth behind/around the ear and in Sweden for headaches and fatigue. Factors distinguishing the two systems (radio frequency emission, phone temperatures and various ergonomic factors) may be responsible for these results, as well as for a secondary finding: a statistically significant association between calling time/number of calls per day and the prevalence of warmth behind/around or on the ear, headaches and fatigue.

Adult↗

[Withdrawal of addictive drugs--patients' experiences?].

BACKGROUND: The prescription of addictive drugs has been a cause for concern. Various small-scale interventions towards patients and doctors have proven effective in terms of cutting down the number of prescriptions. However, little is known about users' experience with withdrawal of addictive drugs; exploring this is the main aim of the present study. MATERIAL AND METHOD: Six focus group sessions with 27 former high and low dosage drug users, mainly of benzodiazepines, were conducted. All groups were audiotaped and analysed by qualitative methods. RESULTS AND INTERPRETATION: Five distinct themes emerged: reasons for drug use initiation, experience of being a user, experience related to drug withdrawal, of leading a life without medication, and experience with and expectations from doctors. Our group members pointed out that drug use was often initiated by the doctor and offered instead of counselling in acute crises. Information on side effects such as addictiveness was reported as largely absent. Both high and low dosage users reported a significant increase in self esteem and ability to cope that was directly related to drug withdrawal and they reported a substantially improved quality of life. Doctors seldom initiated drug reduction strategies and were largely regarded as absent during the withdrawal process. Our informants wanted better care, information and ability to communicate from their doctors, but also stricter prescription strategies and systematic control mechanisms.

Analgesics, Opioid↗

Assessing the empirical validity of the "take-the-best" heuristic as a model of human probabilistic inference.

The boundedly rational 'Take-The-Best" heuristic (TTB) was proposed by G. Gigerenzer, U. Hoffrage, and H. Kleinbölting (1991) as a model of fast and frugal probabilistic inferences. Although the simple lexicographic rule proved to be successful in computer simulations, direct empirical demonstrations of its adequacy as a psychological model are lacking because of several methodical problems. In 4 experiments with a total of 210 participants, this question was addressed. Whereas Experiment 1 showed that TTB is not valid as a universal hypothesis about probabilistic inferences, up to 28% of participants in Experiment 2 and 53% of participants in Experiment 3 were classified as TTB users. Experiment 4 revealed that investment costs for information seem to be a relevant factor leading participants to switch to a noncompensatory TTB strategy. The observed individual differences in strategy use imply the recommendation of an idiographic approach to decision-making research.

Adult↗

A convenient and adaptable package of computer programs for DNA and protein sequence management, analysis and homology determination.

We describe the further development of a widely used package of DNA/protein sequence analysis programs (1). Important revisions have been made based on user experience, and new features, multi-user capability, and a set of large scale homology programs have been added. The programs are very user friendly, economical of time and memory, and extremely transportable. They are written in a version of FORTRAN which will compile, with a few defined changes, as FORTRAN 66, FORTRAN 77, FORTRAN IV, FORTRAN IV+, and others. They are running on a variety of microcomputers, minicomputers, and mainframes, in both single user and multi-user configurations.

Amino Acid Sequence↗

DXplain on the Internet.

DXplain, a computer-based medical education, reference and decision support system has been used by thousands of physicians and medical students on stand-alone systems and over communications networks. For the past two years, we have made DXplain available over the Internet in order to provide DXplain's knowledge and analytical capabilities as a resource to other applications within Massachusetts General Hospital (MGH) and at outside institutions. We describe and provide the user experience with two different protocols through which users can access DXplain through the World Wide Web (WWW). The first allows the user to have direct interaction with all the functionality of DXplain where the MGH server controls the interaction and the mode of presentation. In the second mode, the MGH server provides the DXplain functionality as a series of services, which can be called independently by the user application program.

Artificial Intelligence↗

A survey of marginal wheelchair users.

Significant numbers of wheelchair users experience difficulties with propulsion due to impaired upper limb function (termed marginal users for this study). A survey of wheelchair users in Tayside, Scotland, was carried out to identify and describe the marginal user population and their propulsion difficulties. Subjects for the survey were identified from the records of National Health Service wheelchair users at Dundee Limb Fitting Centre. Subjects were interviewed at home about their wheelchair-propelling experiences. Survey results indicated that marginal users represent approximately 15% of the occupant-propelled wheelchair population. The average age of the marginal users surveyed was 48 years and the modal diagnosis was multiple sclerosis. Fifty-nine percent of the marginal users questioned felt that their wheelchairs were not adequate for their requirements.

Adolescent↗