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PubMed2001

End-user support: a necessary issue in the implementation and use of EPR systems.

A successful integration of an IT-system is dependent not only of the quality of the information and the user interface features of the system but also of the organizations ability to support the users learning process. As IT is becoming more and more pervasive in the Health Care sector as such there is a need for a systematic approach to the question on how to support end-users. Based on an empirical study of an implementation process in a Danish Primary Health Care Services the concept of end-user support is discussed and it is argued that there is a need for a distinction between different kinds of support depending of the type of activity involved. First the organizations strategy for learning when the system was implemented is described. The evaluation of the learning strategy revealed that there was a need for different kinds of knowledge involving qualitatively different kinds of learning. Second the area of end-user support is discussed and it is argued that the common understanding of end-user support as something provided by DP staff, vendors or manuals are to narrow. Third a more differentiated way of thinking of support that link the need for different kind of knowledge and learning processes to different kinds of support is proposed. Finally Activity Theory is put forward as a possible basis that provide the opportunity of discussing issues belonging to different kinds of end-user support within an integrated framework.

Computer User Training↗

PubMed1999

Regional drug information service.

BACKGROUND: Drug information centers (DICs) were established in Europe more than two decades ago. The majority of German DICs were created in the 90s. The regional University hospital-based DIC, which offers services to physicans, is now in operation for three and a half years . OBJECTIVE: To evaluate the types of enquiries received and the profile of the users of a drug information service. METHODS: The working procedure at a regional center in Dresden, Germany, is described. The topics for consultation (adverse reactions, pharmacokinetics, etc.) are presented, and the types of drugs involved are classified according to the Anatomical Therapeutic Chemical (ATC) classification. Users are grouped by medical specialty. Future plans for the DIC are discussed. RESULTS: A total of 516 enquiries were received. Questions concerning therapeutic use (34%), adverse drug reactions (28%), pregnancy/lactation (16%), and pharmacokinetics/dosage (15%) were asked most frequently. Cardiovascular drugs (20%), systemic antiinfectives (19%) as well as drugs targeting the central nervous system (15%) and alimentation/metabolism (9%) were the predominant foci of enquiries. The major users of the DIC were internists (19%), general practitioners (19%), pediatricians (18%), and gynecologists (11%). CONCLUSIONS: The types of questions and users of this service were generally similar to those recorded at many other European DICs. The service has begun producing educational bulletins on drug-related topics of clinical relevance.

Drug Information Services↗

PubMed2004

A comprehensive system of pharmaceutical care for drug misusers.

This article outlines the evolution of a community pharmacy-based supervised consumption of methadone program in Grater Glasgow. The formalization of this program in 1994 promoted full patient compliance with the methadone regimen and reduced seepage of the drug to the illicit market. 184 of the area's 215 community pharmacies now dispense methadone for the treatment of opiate dependence. Of these, 173 have a supplementary contract with the local health board to supervise the consumption of methadone on their premises. In addition 15 of "methadone" pharmacists are involved in the provision of a pharmacy based needle exchange scheme. This has been shown to be the most efficient and cost effective method of delivering clean injecting equipment to injecting drug users in the Greater Glasgow area. Glasgow's pharmacists' have now been involved in the methadone and needle exchange programs for more than ten years. The support needed by pharmacists and the steps that have been put in place to provide this level of commitment are described. The development of the Glasgow pharmacy based services to drug users has had a major impact on practice elsewhere in the United Kingdom.

Journal Article↗

PubMedDate not supplied

An overview of the CEREC 3D CAD/CAM system.

Computer-aided design/computer-aided manufacture (CAD/CAM) technology has made steady inroads into the practice of dentistry. The CEREC CAD/CAM system can be used chairside to fabricate porcelain and composite inlays, onlays, and crowns and porcelain veneers. The latest incarnation of the CEREC system is the CEREC 3D, which provides a versatile, relatively simple, user-friendly method for fabricating esthetic restorations chairside without involving a dental laboratory. CEREC 3D may be the system that allows the average general dentist to provide chairside porcelain restorations during single-visit appointments, eliminating the need for an elastomeric impression or an interim restoration as well as the expense of a laboratory fee.

Ceramics↗

PubMed1988

Use of oral contraceptives in women of older reproductive age.

Evidence of increased risk for cardiovascular disease in oral contraceptive users of older reproductive age is based on early data involving formulations containing higher doses of estrogen and progestin than those in use today. In addition, early studies included patients who would not receive oral contraceptives with today's more stringent prescribing criteria. When these data were carefully analyzed, a significant increase in myocardial infarction was noted only in oral contraceptive users with concomitant risk factors for cardiovascular disease. Analysis of other studies also showed a significant increase in the incidence of cardiovascular disease and mortality only in oral contraceptive users older than age 35 years who smoked. A recent long-term cohort study of women without risk factors for cardiovascular disease who mainly used oral contraceptives containing less than or equal to 50 micrograms estrogen showed no increased risk of myocardial infarction or cerebrovascular accident with oral contraceptive use. Use of oral contraceptives containing less than 50 micrograms estrogen has not been shown to be associated with an increased risk of cardiovascular disease in healthy, nonsmoking women 35 to 45 years of age.

Adult↗

PubMed2003

Statistical analysis of correlated data using generalized estimating equations: an orientation.

The method of generalized estimating equations (GEE) is often used to analyze longitudinal and other correlated response data, particularly if responses are binary. However, few descriptions of the method are accessible to epidemiologists. In this paper, the authors use small worked examples and one real data set, involving both binary and quantitative response data, to help end-users appreciate the essence of the method. The examples are simple enough to see the behind-the-scenes calculations and the essential role of weighted observations, and they allow nonstatisticians to imagine the calculations involved when the GEE method is applied to more complex multivariate data.

Body Height↗

PubMed1991

Staff involvement in critical care unit construction.

In summary, the role of the user group (staff) cannot be underestimated in the successful planning and designing of critical care units. Staff are the occupants of the new area and as such, have valuable input into the design of the space. Architects, planners, designers, and administrators are well advised to solicit this input early in the planning/design process. Critical care staff, as well, have a responsibility to participate in this process. Patients and staff will benefit greatly for a long period of time due to these joint efforts.

Equipment and Supplies, Hospital↗

PubMed2003

Social and institutional feasibility of recycling nutrients in waste in Southern Thailand.

The social and institutional feasibility of recycling plant nutrients in waste in three case study areas, Phattalung, Kuan Lang and Prik, in Southern Thailand has been studied. Three sanitation systems (existing with modifications and alternative) in each area have been evaluated with respect to their acceptance among the local stakeholders and accommodation within the Thai legal framework. Culturally, most proposed recycling methods were accepted by local users, and great interest was expressed towards many of the proposed sanitation systems, except recycling methods involving direct contact with human excreta in Prik (Islamic culture). The three existing systems were assessed to be the most convenient and practical among the nine, due to their low maintenance requirement and the low user fees. The proposed modified and alternative sanitation systems involved higher public participation and thereby a change in the understanding of where the responsibility of managing people's waste products should be placed. Institutionally all nine sanitation systems were accepted by local administrators and all recycling systems were well accommodated within the Thai legal framework. Thus recycling plant nutrients in waste seem both social and institutionally acceptable in Southern Thailand.

Agriculture↗

PubMed1987

Quantitative studies on menstrual blood loss in IUD users.

Despite the introduction of new intrauterine devices (IUDs), the most important complication involving their use continues to be excessive menstrual bleeding. IUD use in developing countries with women who are already depleted in body iron stores may prove to be deleterious to their health. Mean amounts of menstrual blood loss (MBL) for women not using contraception in the western world is about 32 ml. This mean is increased to 52-72 ml with use of the Lippes loop and other non-medicated devices up to 24 months after insertion. For the Copper-7 and Copper-T-200 devices this mean increase is to 37-40 ml in the first month, decreasing to 30-38 ml at 12 months after IUD insertion. In the users of the Multiload-250 IUD at one month post-insertion the MBL is from 56 to 63 ml and from 36 to 39 ml at 24 months of use. The mean Multiload-375 device users at one month after insertion lose a mean of 45-73 ml at 24 months, 35-50 ml. With the progestogen-releasing IUD mean MBL is 27-36 ml at 1 month and 9-13 ml at 12 months post-insertion. Intermenstrual blood loss is significant only in the first month of use for all IUDs. Discontinuation rates for pain and bleeding with non-medicated IUDs are from 11.0-19.6 per 100 women per year, and for the copper IUDs 4.4 to 6.8 per 100 women in the first year of use. The main problem with prolonged menstrual bleeding is depletion of the body iron stores; this is highly significant with non-medicated devices, less important with copper devices and conversely, iron stores are increased in users of progestogen-releasing devices. This is based on serum ferritin measured up to 24 months after insertion. The ferritin values correlated well with the volumes of MBL. It is suggested, especially for women with low body iron stores, that there is an order of preference for IUDs to be used. This should be: firstly, the progestogen-releasing devices; secondly, the Copper-T and Copper-7 IUDs; thirdly the larger surface copper devices (Cu-T-220C, Multiload 250 and 375, Cu-T-380). Non-medicated devices are not to be recommended for these women.

Anemia, Hypochromic↗

PubMed2005

Fixing the system? The experience of service users of the quasi-market in disability services in Australia.

A qualitative study involving semi-structured interviews with 31 people with disabilities and 32 carers in the state of Queensland, Australia, found that their experience of supportive service delivery had not improved despite reforms of the service delivery system driven by a version of the quasi-market model. Instead of delivering increased consumer choice and improved efficiency in service delivery, service users experienced inadequate service supply, service cutbacks, and an increased emphasis on cost subsidisation and assessment processes. Additionally, few consumers felt that individualised funding arrangements had personally delivered the benefits which the quasi-market model and associated policy paradigm had indicated that they should receive. For many consumers, the notion of consumer 'choice' around service provision was fictitious and they felt that any efficiency gains were at the agency level, largely at the consumers' cost. It is concluded that there appears to be no particular benefit to service users of quasi-market reforms, particularly in policy contexts where service delivery systems are historically under-funded.

Community Health Services↗

PubMed1996

The use of qualitative methods in the study of parents' experiences of care on a children's surgical ward.

User satisfaction with the care of hospitalized children is examined in this paper. It is argued that parents are proxy consumers but that their status is conditional on the way in which they exercise choices. Parents' involvement in the care of their children means that the term 'user' is more appropriate than 'consumer'. Methodological problems in the assessment of user satisfaction are discussed. A study of the experiences of parents of 24 children discharged from a surgical ward of a children's hospital is described and the implications for the assessment of user satisfaction reviewed. The study demonstrates that qualitative methods have value in the assessment of user satisfaction with care. A particular strength of qualitative methods of inquiry is that limitations of users' choice in care can be assessed.

Child↗

PubMed1980

Early life-style differences among black male heroin addicts and their nonaddicted friends.

To determine whether early life-style variables (i.e., involvement in illicit drug use and other illegal activities) might be associated with subsequent patterns of heroin use, we conducted personal history interviews with 186 Black male heroin addicts, experimenters, and nonheroin users. Our findings indicate that patterns of heroin use should be viewed within the broader context of involvement in a deviant life-style. Addicts and heavy experimenters were more likely than moderate experimenters or nonheroin users to have been heavy users of illicit drugs such as marijuana, barbiturates, amphetamines, and codeine cough syrup and to have been involved in illegal activities such as drug dealing, property offenses, and violent crimes during or after leaving high school.

Adult↗

PubMed1984

Cost and usage of health sciences libraries: economic aspects.

A study of ninety-five health sciences libraries, obtaining nearly 24,000 user responses, provides estimates of the national cost of library services through the three principal services of circulation, reference, and in-house use; and for four types of users: persons interested in patient care, those interested in research, those involved in education, and others. Unit costs of the three principal services are reported and differences in their relative importance are described. National totals for nine classes of libraries are reported as well as costs by service, user, and function: patient care, research, education, or other. The national expenditure in 1982 was approximately $365 million. The study establishes a method for obtaining results that can be compared and combined across libraries.

California↗

PubMed1999

Selection of hospital information systems: user participation.

Motivated by economic and quality management issues, many hospitals strive for the introduction of information systems into the clinical environment. To introduce the most suitable software product, a systematic selection procedure is required involving all affected staff. The paper describes a methodology that guides the clinical users to an objective motivated decision. This semi-formal methodology is necessary in view of missing standard models for the description of hospital information systems and leads to high acceptance in practical use. The methodology consists of structured product demonstrations with a quantitative assessment, benefit-value-analyses based on step weights for the functions needed, and test installations. Prerequisite of this procedure was the definition of objectives and priorities in a standard catalog that was used as reference in the whole project. Selecting a software product following this systematic procedure establishes a sound basis for a successful application in the clinical environment.

Cost-Benefit Analysis↗

PubMed2002

Improving the quality of hospital services: how diverse groups of consumers prefer to be involved.

Consumer participation in hospitals is increasingly being advocated for as a way to contribute to improving safety and quality. This article reports on the results of a study conducted to investigate if, and how, a range of consumers would prefer to be involved in improving the quality of hospital services. Face-to-face interviews were conducted with 100 users of a hospital, telephone interviews were conducted with 2,005 members of the broader South Australian community, focus groups were conducted with 22 representatives of consumer and community groups and in-depth interviews conducted with four representatives who could not attend the focus groups. The results indicate that for users of the hospital and members of the broader community, there is a significant preference to be involved in more passive methods of participation that are initiated by the hospital, such as written and phone surveys. This is preferable to writing letters of complaint or compliment, participating in more active methods that require one-off commitment (focus groups and public planning forums) and ongoing commitment such as being members of working groups to address specific issues and hospital committees. In contrast, representatives of consumer and community groups have a strong preference to be involved in active methods of participation such as working groups to address specific issues and hospital committees. We found that there are considerable differences between age groups and educational attainment and preference for participation. If these issues are not taken into account, and a range of participation methods used, then there is the potential for some population groups to be excluded from having some input into improving the safety and quality of hospital services.

Adolescent↗

PubMedDate not supplied

A medical image object-oriented database with image processing and automatic reorganization capabilities.

The paper presents the medical image database developed for use in the methodological research environment and in the laboratory clinical environment, designed to be capable of being interfaced to an image processing system. This database is intended to solve the numerous problems due to the complexity-multidimensionality and multimodality-of medical images. These problems are posed in terms of management, archiving, structuring and accessing of this archive, and specification of the interfaces with users and with image processing system Solving these problems involves making a formal description of the image and the data associated with the image, while taking into account the specifics of medical imaging. The kernel which contains this description allows the physical architecture of the management and archiving system to be decoupled from its logical architecture. This decoupling is essential in order to automate the recording of new data, the automatic reorganization of the system scheme in the event of change in the system environment, and to help in consulting the database.

Algorithms↗

PubMed2000

An ultra-fast user-steered image segmentation paradigm: live wire on the fly.

We have been developing general user steered image segmentation strategies for routine use in applications involving a large number of data sets. In the past, we have presented three segmentation paradigms: live wire, live lane, and a three-dimensional (3-D) extension of the live-wire method. In this paper, we introduce an ultra-fast live-wire method, referred to as live wire on the fly, for further reducing user's time compared to the basic live-wire method. In live wire, 3-D/four-dimensional (4-D) object boundaries are segmented in a slice-by-slice fashion. To segment a two-dimensional (2-D) boundary, the user initially picks a point on the boundary and all possible minimum-cost paths from this point to all other points in the image are computed via Dijkstra's algorithm. Subsequently, a live wire is displayed in real time from the initial point to any subsequent position taken by the cursor. If the cursor is close to the desired boundary, the live wire snaps on to the boundary. The cursor is then deposited and a new live-wire segment is found next. The entire 2-D boundary is specified via a set of live-wire segments in this fashion. A drawback of this method is that the speed of optimal path computation depends on image size. On modestly powered computers, for images of even modest size, some sluggishness appears in user interaction, which reduces the overall segmentation efficiency. In this work, we solve this problem by exploiting some known properties of graphs to avoid unnecessary minimum-cost path computation during segmentation. In live wire on the fly, when the user selects a point on the boundary the live-wire segment is computed and displayed in real time from the selected point to any subsequent position of the cursor in the image, even for large images and even on low-powered computers. Based on 492 tracing experiments from an actual medical application, we demonstrate that live wire on the fly is 1.3-31 times faster than live wire for actual segmentation for varying image sizes, although the pure computational part alone is found to be about 120 times faster.

Algorithms↗

PubMed1997

Antigovernment sentiment and support for universal access to care: are they incompatible?

OBJECTIVES: Attitudes toward universal access to medical care were examined to determine whether support for it among people opposed to government involvement in health care was modified by three proxy measures of self-interest: being uninsured, in poor health, or a high user of medical care. METHODS: Data on support for universal access, attitudes toward government involvement in health care, and the indicators of self-interest were obtained from a representative sample of adult Oklahomans (n = 1547) surveyed between October 1992 and December 1994. Forced-order multiple regression with interaction terms was the data analysis technique. RESULTS: People opposed to government involvement in health care were found to be less likely to favor universal access to medical care, but poor health, lack of insurance, and high usage of medical care moderated this effect. CONCLUSIONS: The findings support the view that antigovernment sentiment need not foreclose the public option for health policymakers. Other considerations such as self-interest may modify the effect of unfavorable attitudes toward government.

Adult↗