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PubMed2004

Listening to young voices: challenges of research with adolescent mental health service users.

Young people who have mental health problems and use the mental health services need to be consulted about their views regarding their experiences of care and treatment in the same way as adults do. Doing research with children and young people is relatively new but it is becoming more common and recent literature highlights a need to balance respect for their voices with responsibility for their best interests. This can be achieved by paying close attention to ethical and methodological issues throughout the course of every study. This paper reviews some of the issues involved in consultation research with adolescent mental health service users, and illustrates them with examples taken from an ongoing study into the experiences of young people in three Scottish child and adolescent mental health services.

Adolescent↗

PubMed1997

Desiderata for product labeling of medical expert systems.

The proliferation and increasing complexity of medical expert systems raise ethical and legal concerns about the ability of practitioners to protect their patients from defective or misused software. Appropriate product labeling of expert systems can help clinical users to understand software indications and limitations. Mechanisms of action and knowledge representation schema should be explained in layperson's terminology. User qualifications and resources available for acquiring the skills necessary to understand and critique the system output should be listed. The processes used for building and maintaining the system's knowledge base are key determinants of the product's quality, and should be carefully documented. To meet these desiderata, a printed label is insufficient. The authors suggest a new, more active, model of product labeling for medical expert systems that involves embedding 'knowledge of the knowledge base', creating user-specific data, and sharing global information using the Internet.

Artificial Intelligence↗

PubMed2004

Derivation of a typology for the classification of risks in emergency medicine.

OBJECTIVES: To develop a graded classification system for risks in emergency medicine. To test the inter-user reliability of this classification system. DESIGN: Prospective collection of data involving emergency department (ED) critical incidents. Derivation of classification system using the collected critical incidents. Comparison of results of classification of a sample of the critical incidents between different users of the system. SETTING: EDs in two teaching hospitals and two district general hospitals (DGHs) in the north west of England. INTERVENTIONS: Observational study. MAIN OUTCOMES: Classification system itself. Results of classification of same critical incidents by different users. RESULTS: 816 critical incidents were identified and used to derive a typology. This typology was found to have inter-user reliability score of 86% (95% confidence intervals 76.4% to 95.6%). CONCLUSIONS: The typology that has been derived is a reliable tool for the classification of risks in emergency medicine.

Diagnostic Errors↗

PubMed2006

The MedlinePlus public user interface: studies of design challenges and opportunities.

QUESTION: What are the challenges involved in designing, modifying, and improving a major health information portal that serves over sixty million page views a month? SETTING: MedlinePlus, the National Library of Medicine's (NLM's) consumer health Website, is examined. METHOD: Challenges are presented as six "studies," which describe selected design issues and how NLM staff resolved them. MAIN RESULT: Improving MedlinePlus is an iterative process. Changes in the public user interface are ongoing, reflecting Web design trends, usability testing recommendations, user survey results, new technical requirements, and the need to grow the site in an orderly way. CONCLUSION: Testing and analysis should accompany Website design modifications. New technologies may enhance a site but also introduce problems. Further modifications to MedlinePlus will be informed by the experiences described here.

Database Management Systems↗

PubMed1993

A multidimensional deconvolution method for evaluating the absorption of drugs undergoing reversible metabolism and presystemic metabolite formation.

A general multidimensional deconvolution method is developed primarily for application to the bioavailability assessment of drugs with reversible metabolism. The proposed approach involves fitting continuous functions to the experimental data and then applying a numerical deconvolution algorithm to the fitted curves. It is shown how the method may be used to determine the rates and extends of drug absorption and presystemic formation of interconversion metabolites. The proposed method is implemented as a FORTRAN subroutine called DCVSYS for the general multidimensional deconvolution problem involving any continuous functions and as a user-friendly PC-compatible program called NDCREV for evaluating the absorption of drugs undergoing reversible metabolism. The methods and computer programs are demonstrated by application to simulated drug and metabolite concentrations for a drug with reversible metabolism.

Absorption↗

PubMed1994

Head-up displays and their automotive application: an overview of human factors issues affecting safety.

In response to the recent innovations to use head-up displays (HUDs) in vehicles, this paper discusses the relevant human factors issues arising from this display format and the potential safety implications. A review is made of the relevant HUD literature, primarily from the aviation field. The primary issues for automotive HUDs relevant to system performance and safety in the driving task involve interference from background scene complexity, system novelty, user perceptual style, cognitive disruption, and perceptual tunnelling. Basic research is necessary to investigate the extent of these issues as well as to resolve fundamental design specifications (e.g. HUD size, shape, placement, information content). It is suggested that the introduction of HUDs into vehicles be carefully considered. This will necessitate not only the reconsideration what constitutes an in-vehicle display, but also what constitutes the information to be conveyed.

Accidents, Traffic↗

PubMed1970

Minimising human problems when introducing automation.

Although considerable thought has been given to human problems arising from the use of automation, very little attention has been devoted to the human problems encountered during its introduction. This article reviews various stages of the design and installation of an automated system from the human aspect. Stress is laid on the need for ergonomics throughout all phases, from analysis of present methods and design of a new system to installation, commissioning and personnel selection and training. An essential need is to involve all levels of the new system's users, from management to operators, at the earliest opportunity.

Journal Article↗

PubMed1991

A model for critiquing based on automated medical records.

We describe the design of a critiquing system, HyperCritic, that relies on automated medical records for its data input. The purpose of the system is to advise general practitioners who are treating patients who have hypertension. HyperCritic has access to the data stored in a primary-care information system that supports a fully automated medical record. Hyper-Critic relies on data in the automated medical record to critique the management of hypertensive patients, avoiding a consultation-style interaction with the user. The first step in the critiquing process involves the interpretation of the medical record in an attempt to discover the physician's actions and decisions. After detecting the relevant events in the medical record, HyperCritic views the task of critiquing as the assignment of critiquing statements to these patient-specific events. Critiquing statements are defined as recommendations involving one or more suggestions for possible modifications in the actions of the physician. The core of the model underlying HyperCritic is that the process of generating the critiquing statements is viewed as the application of a limited set of abstract critiquing tasks. We distinguish four categories of critiquing tasks: preparation tasks, selection tasks, monitoring tasks, and responding tasks. The execution of these critiquing tasks requires specific medical factual knowledge. This factual knowledge is separated from the critiquing tasks and is stored in a medical fact base. The principal advantage demonstrated by HyperCritic is the adaption of a domain-independent critiquing structure. We show how this domain-independent critiquing structure can be used to facilitate knowledge acquisition and maintenance of the system.

Artificial Intelligence↗

PubMed2004

Can the practitioner correctly predict outcome in motivational interviewing?

We have examined whether practitioner ratings (immediately post-intervention) or other recorded characteristics of a single-session 1-hour motivational intervention were predictive of 3-month cannabis use outcome. In the context of a cluster randomized trial involving 200 non help-seeking illegal drug users (age range 16-20), 105 were randomized to the intervention, of whom 97 (92%) were interviewed for followup at 3 months, 96 of whom were current cannabis users at study entry. Six intervention characteristics and seven practitioner ratings as well as patterns of self-motivational statements were investigated in relation to substantial change in use, (which was defined as cessation or reduction by more than 50%). Both practitioner ratings post-session, and also the subject's own elicited self-motivational statements, were found to be predictive of outcome 3 months later. The strongest predictor of substantial change, however, was simply whether change had been discussed during the session. On the basis of the above findings, it does indeed appear possible for outcome to be predicted by the motivational interviewing practitioner immediately following delivery of the intervention, on the basis of simple observations and ratings. This area warrants more specific study.

Adolescent↗

PubMed2006

Comparative aspects of somatic cell nuclear transfer with conventional and zona-free method in cattle, horse, pig and sheep.

Nuclear transfer (NT) is a complex procedure that requires considerable technical skills. Over the years attempts have been made to simplify the micromanipulations involved and to make the procedure more user-friendly. A significant step forwards has been the development of the zona-free NT methods. We have used zona-free NT with mechanical aspiration of the metaphase plate as a mean of enucleation, in a comparative approach with the conventional nuclear transfer zona-enclosed method in cattle, horse, sheep and pig. The absence of the zona considerably facilitates the enucleation step and significantly increases cell fusion success. On the other hand, the culture of zona-free NT embryos requires the embryos to be cultured individually or anyway separated from each other to avoid aggregation and also requires to prolong the in vitro culture up to the blastocyst stage before transfer. Blastocyst rate is equal or higher with zona-free method as compared to zona-enclosed method while survival after cryopreservation and development to term is comparable. In conclusion, our findings, together with published data, demonstrate that the zona-free system described in this paper can significantly increase the output of NT blastocysts over the conventional zona-enclosed system.

Animals↗

PubMed1998

Accuracy of a new wrist cuff oscillometric blood pressure device: comparisons with intraarterial and mercury manometer measurements.

Accurate measurement of arterial blood pressure is of great importance for the diagnosis and treatment of hypertension. Because of the chronic nature of antihypertensive drug therapy, the involvement of the patient in blood pressure control is desirable. Such an involvement, however, is only feasible if simple, user-friendly, and precise blood pressure measurement devices are available. In this study we tested a new wrist cuff oscillometric blood pressure measurement device in 100 consecutive patients undergoing cardiac catheterization. Blood pressures were simultaneously taken intraarterially (axillary artery) and with a mercury manometer and stethoscope or noninvasive measurement device (OMRON R3). Intraarterial measurements were directly compared with two measurements taken in random order with either an arm cuff mercury manometer or the wrist cuff device. Systolic and diastolic blood pressure as assessed with the mercury manometer was higher, especially when compared with the intraarterial and the wrist cuff values, which were comparable. Correlations of blood pressure values with intraarterial measurement were 0.86 systolic and 0.75 diastolic (P < .01) for the wrist cuff and 0.84 systolic (P < .01) and 0.59 diastolic (P < .05) for the mercury manometer measurements. Reproducibility of both measurements was good for the wrist cuff device ([systolic/diastolic]: r = 0.94/0.92; P < .01) and the mercury manometer (r = 0.97/0.88; P < .01). Both methods overestimated high diastolic values, whereas only the wrist cuff underestimated high systolic values. Thus, the new oscillometric wrist cuff blood pressure measurement device measures arterial blood pressure with great accuracy and reproducibility. As compared with intraarterial values, the wrist cuff device overestimated high diastolic and underestimated high systolic blood pressure values. Blood pressure values as measured by the mercury manometer were higher than intraarterial values and those of the wrist cuff. Both noninvasive devices overestimated high diastolic values.

Blood Pressure Determination↗

PubMed2003

Ocular side-effects in breast cancer patients treated with tamoxifen and toremifene: a randomized follow-up study.

PURPOSE: 3Tamoxifen and toremifene are non-steroidal anti-oestrogens widely used in the treatment of advanced breast cancer and as adjuvant therapy following surgery in early stage disease. Tamoxifene has also been approved for use in reducing the incidence of breast cancer amongst high risk women. However, certain well documented adverse effects, mainly involving the reproductive organs, have been reported amongst users of both drugs. The aim of this study was to monitor the ocular side-effects of both of these commonly used anti-oestrogens. METHODS: Sixty postmenopausal (age range 50-79 years) breast cancer patients were randomized into adjuvant tamoxifen or toremifene therapy groups for 3 years. Prior to commencement of medication, a thorough ocular examination was undertaken. The first follow-up visit took place after 6 months and the remaining three at 12-month intervals thereafter. RESULTS: Sixteen patients had cataract at the first visit (seven in the tamoxifen group and nine in the toremifene group). Ten patients developed cataract during the study period (five in each group), giving annual cataract rates of 6.8% and 6.2% in the tamoxifen and toremifene groups, respectively. Three patients had macular crystals at the first visit (one in the tamoxifen group and two in the toremifene group). The crystals remained stable throughout the follow-up. Macular drusen were diagnosed in five patients at the first ophthalmological check-up (two in the tamoxifen and three in the toremifene group). Two patients in the toremifene group developed drusen maculopathy during follow-up visits. Yellowish spots in the macular area were found in one tamoxifen-treated patient at the second visit. At the final visit after 3.5 years' follow-up the spots had disappeared. No abnormal corneal findings or keratopathy were documented during the follow-up. CONCLUSION: We observed no serious ocular side-effects among the 60 breast cancer patients treated with tamoxifen or toremifene over a 3.5-year period.

Aged↗

PubMed2003

Treatment of Tourette syndrome with delta-9-tetrahydrocannabinol (delta 9-THC): no influence on neuropsychological performance.

Previous studies provide evidence that marijuana (Cannabis sativa) and delta-9-tetrahydrocannabinol (Delta(9)-THC), the major psychoactive ingredient of marijuana, respectively, are effective in the treatment of tics and behavioral problems in Tourette syndrome (TS). It, therefore, has been speculated that the central cannabinoid receptor system might be involved in TS pathology. However, in healthy marijuana users there is an ongoing debate as to whether the use of cannabis causes acute and/or long-term cognitive deficits. In this randomized double-blind placebo-controlled study, we investigated the effect of a treatment with up to 10 mg Delta(9)-THC over a 6-week period on neuropsychological performance in 24 patients suffering from TS. During medication and immediately as well as 5-6 weeks after withdrawal of Delta(9)-THC treatment, no detrimental effect was seen on learning curve, interference, recall and recognition of word lists, immediate visual memory span, and divided attention. Measuring immediate verbal memory span, we even found a trend towards a significant improvement during and after treatment. Results from this study corroborate previous data suggesting that in patients suffering from TS, treatment with Delta(9)-THC causes neither acute nor long-term cognitive deficits. Larger and longer-duration controlled studies are recommended to provide more information on the adverse effect profile of THC in patients suffering from TS.

Adolescent↗

PubMed2005

Abstinence-induced changes in self-report craving correlate with event-related FMRI responses to smoking cues.

Drug cues have been shown to activate brain regions involved in attention, motivation, and reward in addicted users. However, as studies have typically measured responses in only one state (ie drug abstinence), it is unclear whether observed activations represent amplification by abstinence or stable responses. Thus, the present study was designed to evaluate the stability of event-related responses to visual drug cues in dependent smokers (n=13) using event-related functional magnetic resonance imaging measures. Imaging was conducted following smoking as usual and following overnight abstinence, and self-reported craving measures were obtained before, during, and after scanning. Analysis of hemodynamic response (HDR) amplitudes in each of 13 regions of interest revealed larger responses to smoking compared to control cues in ventral anterior cingulate gyrus (vACG) and superior frontal gyrus. Responses to smoking cues in these and all other regions revealed no effects of abstinence/satiety, thus supporting the notion that cue-elicited brain responses are relatively stable. However, while the abstinence manipulation did not alter group-level responses to smoking cues, at the individual level, abstinence-induced changes in craving (abstinence minus satiety) were positively correlated with changes in HDR amplitude to smoking cues in frontal regions including left inferior frontal gyrus, left vACG, and bilateral middle frontal gyrus. These results suggest that brain responses to smoking cues, while relatively stable at the group level following short-term abstinence, may be modulated by individual differences in craving in response to abstinence-particularly in regions subserving attention and motivation.

Adult↗

PubMed2002

The role of actigraphy in sleep medicine.

During the last decade actigraphy (activity-based monitoring) has become an essential tool in sleep research and sleep medicine. The validity, reliability and limitations of actigraphy for documenting sleep-wake patterns have been addressed. Normative data on sleep-wake patterns across development have been collected. Multiple studies have documented the adequacy of actigraphy to distinguish between clinical groups and to identify certain sleep-wake disorders. Actigraphy has also been shown to be effective in documenting the effects of various behavioral and medical interventions on sleep-wake patterns. Actigraphy is less useful for documenting sleep-wake in individuals who have long motionless periods of wakefulness (e.g. insomnia patients) or who have disorders that involve altered motility patterns (e.g. sleep apnea). Potential users should be aware of a number of pitfalls of actigraphy: (1) validity has not been established for all scoring algorithms or devices, or for all clinical groups; (2) actigraphy is not sufficient for diagnosis of sleep disorders in individuals with motor disorders or high motility during sleep; (3) the use of computer scoring algorithms without controlling for potential artifacts can lead to inaccurate and misleading results.

Humans↗

PubMed2001

Overcoming methodological concerns in the investigation of online sexual activities.

Online Sexual Activity (OSA) is an important and growing phenomenon. Prior research in this area has been criticized on methodological grounds. This study examines the reliability of Internet research regarding online sexual activities by comparing a selected random sample to a convenience sample. Participation in the selected random sample was limited to every 1,000th visitor to the MSNBC website in June 2000. Participation in the convenience sample was available to anyone with access to the Internet during the same time period. Most differences between these samples indicated that, relative to a selected random sample, a significantly greater proportion of Internet users in the convenience sample had a heavier involvement with OSA, including online sexual difficulties. We discuss the methodological and clinical implications of this finding.

Adult↗

PubMed2006

Towards pathogenomics: a web-based resource for pathogenicity islands.

Pathogenicity islands (PAIs) are genetic elements whose products are essential to the process of disease development. They have been horizontally (laterally) transferred from other microbes and are important in evolution of pathogenesis. In this study, a comprehensive database and search engines specialized for PAIs were established. The pathogenicity island database (PAIDB) is a comprehensive relational database of all the reported PAIs and potential PAI regions which were predicted by a method that combines feature-based analysis and similarity-based analysis. Also, using the PAI Finder search application, a multi-sequence query can be analyzed onsite for the presence of potential PAIs. As of April 2006, PAIDB contains 112 types of PAIs and 889 GenBank accessions containing either partial or all PAI loci previously reported in the literature, which are present in 497 strains of pathogenic bacteria. The database also offers 310 candidate PAIs predicted from 118 sequenced prokaryotic genomes. With the increasing number of prokaryotic genomes without functional inference and sequenced genetic regions of suspected involvement in diseases, this web-based, user-friendly resource has the potential to be of significant use in pathogenomics. PAIDB is freely accessible at http://www.gem.re.kr/paidb.

Bacteria↗

PubMedDate not supplied

Personal emergency response systems.

A personal response system is a signaling device that summons help during an emergency. Although personal response systems vary widely, there are three components. The first component is the electronic hardware in the home, which consists of portable and installed sensors and the control console. The second component is the emergency response center, which is either provider-based or manufacturer-based. The third component involves the dispatch of appropriate assistance. The primary users of personal response systems are women in their seventies and eighties who live alone and who have cardiac and musculoskeletal problems, which make them prone to falls. The frequency of personal response system use varies from an average of 0.44 to 0.84 emergencies per subscriber per year. Program coordinators believe that personal response systems help to delay institutionalization, reduce admissions to hospitals, substantially shorten hospital stays, and reduce the duration of home attendant services. The most favorable impact of the personal response system has been its psychologic value to the users and their families.

Aged↗