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Cocaine hallucinations.

The author reviews the literature on hallucinations that occur as a result of acute and chronic administration of cocaine. He examined the phenomenology of cocaine hallucinations in a group of 85 recreational cocaine users, 15 of whom reported hallucinatory experiences in visual, tactile, olfactory, auditory, and gustatory modalities. He discusses a new phenomenon of "snow lights" in terms of initiating a progression of symptoms leading to the classic "cocaine bugs." He also points out the similarity of cocaine hallucinations to entoptic phenomena and migraine hallucinations, which suggests a common mechanism of action based on CNS excitation and arousal.

Adult↗

Implementing information technology in the NHS: the role of narrative.

This paper analyses how groups use narratives in social processes of sensemaking and identity construction and in the pursuit and legitimation of their selfish interests. It does so through an examination of the narrativity of the experiences reported by the developers and users of an information technology (IT) system linking a haematology laboratory and a specialist haematology ward in a large acute hospital. The research contribution the paper makes is twofold. First, it illustrates the importance of group-level narratives in enacting organizational realities and especially in the social construction of IT systems. Second, it suggests that the narrative understanding of groups is a significant domain of organizational inquiry because it is through the spread and acceptance of their narratives that groups exercise their most profound influence.

Clinical Laboratory Information Systems↗

Consensus development methods: a review of best practice in creating clinical guidelines.

BACKGROUND: Although there is debate about the appropriate place of guidelines in clinical practice, guidelines can be seen as one way of assisting clinicians in decision-making. Given the likely diversity of opinion that any group of people may display when considering a topic, methods are needed for organising subjective judgements. Three principal methods (Delphi, nominal group technique, consensus development conference) exist which share the common objective of synthesising judgements when a state of uncertainty exists. OBJECTIVES: To identify the factors that shape and influence the clinical guidelines that emerge from consensus development methods and to make recommendations about best practice in the use of such methods. METHODS: Five electronic databases were searched: Medline (1966-1996), PsychLIT (1974-1996), Social Science Citation Index (1990-1996), ABI Inform and Sociofile. From the searches and reference lists of articles a total of 177 empirical and review articles were selected for review. RESULTS: The output from consensus development methods may be affected by: the way the task is set (choice of cues, recognition of contextual cues, the focus of the task, the comprehensiveness of the scenarios); the selection of participants (choice of individuals, degree of homogeneity of the group, their background, their number); the selection and presentation of scientific information (format, extent to which its quality and content is assessed); the way any interaction is structured (number of rating rounds, ensuring equitable participation, physical environment for meetings); and the method of synthesising individual judgements (definition of agreement, rules governing outliers, method of mathematical aggregation). CONCLUSIONS: Although a considerable amount of research has been carried out, many aspects have not been investigated sufficiently. For the time being at least, advice on those aspects has, therefore, to be based on the user's own commonsense and the experience of those who have used or participated in these methods. Even in the long term, some aspects will not be amenable to scientific study. Meanwhile, adherence to best practice will enhance the validity, reliability and impact of the clinical guidelines produced.

Benchmarking↗

Automating research data collection.

This article reviews the capabilities, advantages, and disadvantages of three forms of automated data collection-scannable data forms, Web-based forms, and handheld computers-compared with the current standard of data entry by hand on paper forms. Each of these methods is reviewed with respect to ease of use, experience required of designer, end-user training requirements, costs, flexibility, speed, accuracy/error rate, potential for data loss, need for technical support, and equipment and/or software requirements. A discussion of their appropriate application to various kinds of studies is included, followed by examples of research studies using each of these methods.

Computer Communication Networks↗

Maternal-infant separation at birth among substance using pregnant women: implications for attachment.

The potential for substance use to interfere with initial maternal-infant contact and attachment was examined. Data were collected from confidential interviews with pregnant women and reviews of the medical charts of these women and their infants. Substance users (N = 60) were found to experience significantly (p = .03) more maternal-infant separation at birth than nonusers (N = 22), most often due to health concerns for mother and/or infant. Substance using mothers scored negatively more frequently than nonusing mothers on variables of attachment. Reasons for these differences are explored and some strategies for dealing with this population in the hospital milieu are suggested.

Female↗

Longitudinal survey of anxiety and depression in drug users and addicts.

As a follow-up to our 1990 study of anxiety and depression among drug users, after two years 44 men differed in their experience with drugs and from the first phase of the study five of the 20 controls became drug users, two of the 20 drug users became addicts, and one of the 20 drug abusers died from AIDS. These findings do not confirm the 1989 thesis of Newcomb and Bentler on the etiology of addiction, that depression and anxiety imply greater drug use. Positive correlations were found for drug use with anxiety and depression. Such data confirm those found by De Mojà in 1990.

Adult↗

Women-specific alcohol use(r) intervention programs: a preliminary dimension analysis based on specialized services in Western New York State.

Women-specific models have been proposed as a means for achieving the best service user-treatment match for women who experience alcohol use related problems. To better understand how theoretical and empirical knowledge are being applied in real world programs, interviews were conducted at seven programs in Western New York State where specialized women's alcohol use(r) services have been developed. A preliminary analytical model of women's services is proposed, consisting of the following three dimensions: 1) level of orthodoxy, 2) population specificity, and 3) change target.

Alcoholism↗

Illicit drug use and consumption of alcohol, tobacco, and over-the-counter medicine among adolescents.

Over 9,000 junior and senior high school students in 79 schools in 10 cities completed an anonymous questionnaire concerning use of and attitudes toward licit and illicit drugs. Single and multivariate analyses indicated strong and statistically significant relationships between the consumption of alcohol, tobacco, and over-the-counter medicines and experience with illicit drugs. Also, the user of illicit drugs is also a relatively frequent user of licit drugs--alcohol, tobacco, and over-the-counter medications. The user is more likely than the nondrug user to be a "trier," if not a consistent consumer, of a variety of different substances. The patterns of relationships held across cities, types of schools, and age levels, and distinguished between those ever using illicit drugs vs never using them, present vs former users, and single vs polydrug users. Various alternative explanations are discussed.

Adolescent↗

HIV prevention among IVDUs in the Federal Republic of Germany: stability and change.

These comments on German drug and AIDS policy are based on the author's two decades of experience in the field of drug user treatment, on recent studies about the epidemiology and etiology of HIV among IVDUs, and on evaluative studies on demonstration projects. German drug use/user policy did not change much in the face of AIDS: no large maintenance or needle-exchange programs were initiated. This is because a well-prepared system of low-threshold methods targeted at IVDUs not ready to undergo treatment was in place before the epidemic. This system has been modified to integrate the aims of HIV prevention among IVDUs and is free of charge and available throughout the country.

Cocaine↗

A CORBA-based object framework with patient identification translation and dynamic linking. Methods for exchanging patient data.

Exchanging and integration of patient data across heterogeneous databases and institutional boundaries offers many problems. We focused on two issues: (1) how to identify identical patients between different systems and institutions while lacking universal patient identifiers; and (2) how to link patient data across heterogeneous databases and institutional boundaries. To solve these problems, we created a patient identification (ID) translation model and a dynamic linking method in the Common Object Request Broker Architecture (CORBA) environment. The algorithm for the patient ID translation is based on patient attribute matching plus computer-based human checking; the method for dynamic linking is temporal mapping. By implementing these methods into computer systems with help of the distributed object computing technology, we built a prototype of a CORBA-based object framework in which the patient ID translation and dynamic linking methods were embedded. Our experiments with a Web-based user interface using the object framework and dynamic linking-through the object framework were successful. These methods are important for exchanging and integrating patient data across heterogeneous databases and institutional boundaries.

Database Management Systems↗

Active Learning Centre: utilization patterns of an interactive educational World Wide Web site.

The advent of the World Wide Web (WWW) provides unique opportunities to transform medical education. Interactive computer assisted instruction has shown promising results but its growth has been impeded by logistical barriers. We designed an interactive WWW site--Active Learning Centre (ALC)--that offers a novel approach to these problems, combining remotely authored databases with computer-generated self-assessment tests. This study analyzes utilization and user assessment of the site. The site was found to be patronized mostly by students and health professionals from English-speaking countries. Users have been pleased with their experience and suggest further expansion of the ALC. Our data have also tentatively shown that their knowledge improved with repeated visits to the site.

Attitude to Computers↗

Health technology assessment.

The developing role and use of diagnostic imaging continue to emerge as disease management paradigms are refined and clinical guidelines are employed more often. Health technology assessment, HTA (also known as health care technology assessment), is fundamentally a form of policy research. By formulating effective HTA, the short- and long-term effects of health care technology are studied in a systematic and multidisciplinary way. The fundamental aim of all HTA is to assist those individuals and organizations who stand to benefit from a new health technology (patients), those who will apply the technology (providers), and those who will pay for it (payers) to make better decisions about the technology they utilize by supplying information that is of a high scientific standard and population-based. Effective HTA is especially useful to health care providers, payers, professional groups in health care, manufacturers, political decision-makers and the general public or consumers of health care technology because it represents a process through which effective technology can be identified and ineffective technology can be understood in the context of its limitations. HTA is a multidisciplinary undertaking requiring combined expertise in clinical medicine, epidemiology, biostatistics, bioengineering, health economics, administration, psychology, sociology, ethics and legal science. Additionally, the experiences and opinions of health technology users and consumers of health care (especially patient advocacy groups) are needed to form an overall accurate understanding of the technology under review.

Costs and Cost Analysis↗

Assumptions, ambiguities, and possibilities in interdisciplinary population health research.

The rhetoric of "interdisciplinary," "multi-disciplinary," and "transdisciplinary" permeates many population health research projects, funding proposals, and strategic initiatives. Working across, with, and between disciplines is touted as a way to advance knowledge, answer more complex questions, and work more meaningfully with users of research. From our own experiences and involvement in the 2003 CIHR Institute for Public and Population Health's Summer Institute, interdisciplinary population health research (IPHR) remains ambiguously defined and poorly understood. In this commentary, we critically explore some characteristics and ongoing assumptions associated with IPHR and propose questions to ensure a more deliberate research process. It is our hope that population health researchers and the CIHR will consider these questions to help strengthen IPHR.

Attitude of Health Personnel↗

Access to dental care among older adults in the United States.

Oral health is essential to an older adult's general health and well-being. Yet, many older adults are not regular users of dental services and may experience significant barriers to receiving necessary dental care. This literature review summarizes national trends in access to dental care and dental service utilization by older adults in the United States. Issues related to geriatric dentistry and concerns about access to dental care include the increasing diversity of the older adult population, concerns about the degree to which the dental workforce is prepared to meet the oral health needs of older patients, and the adequacy of the future workforce, including concern about training opportunities in gerontology and geriatrics for dental and allied dental practitioners.

Aged↗

An evaluation of an automated anesthesia record keeping system.

Mayo Clinic makes use of an automated anesthesia record keeping system in its cardiovascular operating rooms. Over 20,000 anesthesia records have been recorded with this system since its installation in 1983. How successful is this system? Does it meet the needs of the anesthesiologist? What are their attitudes towards the computer? A questionnaire survey was conducted to solicit the experiences, opinions, and recommendations of the users of this system. The results are described in this paper. The feedback will be used to determine the tasks and their priority for improving the current system, and to define the requirements for future computerization to meet the needs of the anesthesiologist in the operating room.

Anesthesiology↗

Utilization and morbidity: random or tandem?

Earlier studies have shown that one in eight children persist in being high users of health care services over long periods of time and, conversely, about the same proportion of children are consistently low users. As these studies failed to discover reasons for these persistent deviations from average, this study explored three possible explanations: persistent morbidity, mental health problem, and familial patterns of use. Although all three phenomena were associated with both persistence of high utilization of services as well as an overall large number of visits, the number of types of morbidity was the most significant correlate of high use. Children who were constantly low users of services were much more likely to have only a few types of morbidity whereas children who were constantly high users were much more likely to experience a wide variety of types of problems. These findings suggest that an understanding of the demand for health services requires an understanding of the interrelationships of illnesses within individuals rather than a focus on particular illnesses or particular types of illnesses.

Acute Disease↗