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PubMed1999

The experiences of one divisional group of GPs in introducing computers into clinical practice.

OBJECTIVES: To explore the experiences of GPs who have introduced computers into their practices, particularly for clinical use. METHODS: GPs who have introduced computers into their practice for clinical use were identified by a telephone survey of the membership of the Monash Division, Melbourne, Victoria. Eleven 'clinical users' participated in semi-structured interviews to elucidate their experiences of installing computers in their consulting rooms, including their beliefs on how this process could have been given more support. RESULTS: Sixty-two of 67 practices participated in the initial telephone survey. Sixteen percent of responding practices were using computers for clinical purposes, with 11% issuing computerised prescriptions. Interviews with clinical users revealed that most had learned about computer hardware and software through their own independent enquiries. However, the GPs believed that divisions have an increasing role in providing training, education, and offering independent advice about the purchase of appropriate computer systems. DISCUSSION: This group of GPs adopted computers for clinical purposes without much assistance from the medical profession. Their experience of the process of computerisation illustrated that lack of training posed problems as did lack of support. Half of the sample felt that divisions may be able to provide training and education, independent advice and act as a forum to discuss and develop ideas, and thus ease some of the problems associated with adopting new technologies. CONCLUSION: Several suggestions are made for GPs and divisions to assist in the process of computerisation.

Australia↗

PubMed1990

Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. IV. Bleeding patterns. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation.

A multicentred clinical trial was conducted in 12 countries to assess the contraceptive efficacy and side effects of a low-dose levonorgestrel-releasing vaginal ring. Contraceptive efficacy and side effects, expulsions and removals, and the relation between pregnancy rate and admission body weight of the women have been reported previously. The effect of ring use on vaginal bleeding patterns as observed from daily menstrual diaries kept by the women is the object of this paper. A total of 1005 women were fitted with the ring and 702 of them provided a menstrual diary suitable for analysis. The description of the bleeding patterns is made using a 90-day reference period approach and following the guidelines published by WHO. In addition the longest bleeding/spotting episode and longest bleeding/spotting-free interval are calculated over the entire diary length. Half of the ring users have vaginal bleeding patterns similar to normal untreated patterns. A quarter experience irregular bleeding, 10% have prolonged cycles and 10% have shortened cycles. Over one year of continuous use, there appears to be no significant trend in these patterns. Users with the worst bleeding patterns tend to discontinue first during the clinical trial and are influenced by their more recent experience of vaginal bleeding irregularities. Life-table analysis of discontinuation rates gives an underestimation of the true incidence of bleeding irregularities. Some comments are made on the limitations of the methods of analysis of menstrual diaries.

Clinical Trials as Topic↗

PubMed1997

[The care principles of home care based on the cognition of care providers].

The purpose of this study was to clarify the care principles that are most highly valued by various care providers, including public health nurses, home visiting nurses, home helpers, and case-workers, by factor-identification-study (KJ method), and to consider measures for sharing care principles among these sectors. It was found that care principles are composed of three factors: "User-oriented care", "Good mutual relationship", and "Self-improvement". Also there are differences in cognition of these according to occupation, workplace, experience, and so on. We should develop strategies for improving the quality of user-oriented care, as we understand the differences in cognition of care principles, and as we share the experience gained in each working aria.

Adult↗

PubMed2003

Longitudinal patterns of drug injection behavior in the ALIVE Study cohort,1988-2000: description and determinants.

The objective of this study was to characterize longitudinal patterns of drug injection behavior for individuals and to identify their early determinants. Participants were 1,339 injection drug users recruited into the AIDS Link to Intravenous Experience (ALIVE) Study in Baltimore, Maryland, through community outreach efforts. The study was initiated in 1988, and follow-up continued through 2000, with semiannual visits. Patterns of self-reported drug injection (yes/no) were defined for each participant, based on the number of drug-use transitions. The effect of baseline factors was assessed using multinomial logistic regression models. Over the 12-year study period, four patterns were noted: 29% of participants remained persistent drug injectors, 20% ceased injection, 14% relapsed once, and 37% had multiple transitions. Persistent injectors had the shortest follow-up and the highest mortality. For persons who changed their behavior, 3.4 years elapsed before their first cessation attempt, on average. Factors differentiating the groups included history of incarceration, young age, participation in drug treatment programs, recent overdose, and commercial sex. The observed long-term injection patterns are consistent with the view of drug addiction as a chronic disease. This view emphasizes the need for prolonged efforts to sustain cessation and to prevent adverse health and social outcomes among injection drug users.

Adult↗

PubMed1990

Hospital health care for HIV infection with particular reference to injecting drug users.

Models of health care developed for HIV and AIDS tend to reflect the experience of San Francisco or London where the majority of patients affected have been homosexual or bisexual. The services developed in these areas may not be appropriate for other risk groups such as injecting drug users. The author, who has been closely involved in developing an HIV service in Edinburgh mainly for injection drug users, undertook a travel fellowship to compare and contrast HIV medical services in Amsterdam, New York and San Francisco with particular regard to what was available for injecting drug users. The provision of drug related and HIV medical services at the same site by the same doctors appears to provide the most efficient service but has yet to be systematically evaluated.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

On the clinical relevance of mismatch negativity: results from subjects with normal hearing and cochlear implant users.

Mismatch negativity (MMN) provides an objective measure for evaluating subjects with problems related to speech processing. For a valid neurophysiological profile of speech-processing mechanisms, an efficient procedure to elicit MMNs is needed. In Experiment 1 of this study, MMN recordings were conducted in adults with normal hearing on the effects of decreasing the duration of the interstimulus interval (ISI). Shortening ISI duration does not seem to have a high impact on the individual MMN quality, whereas it does influence group MMN quality. In Experiment 2, MMNs were elicited in a group of cochlear implant users by using a speech sound contrast/ba/-/da/. A group of good performers produced a significant MMN, whereas a group of moderate performers did not. There seems to be a relation between speech perception ability and MMN quality. To fundamentally understand the effects of electrical stimulation of the inner ear and to clinically adjust rehabilitation, diverse data are needed on different aspects of auditory processing. Optimizing the procedure to elicit and MMN is therefore of great clinical value.

Adult↗

PubMed2006

Opiate users' knowledge about overdose prevention and naloxone in New York City: a focus group study.

BACKGROUND: Drug-induced and drug-related deaths have been increasing for the past decade throughout the US. In NYC, drug overdose accounts for nearly 900 deaths per year, a figure that exceeds the number of deaths each year from homicide. Naloxone, a highly effective opiate antagonist, has for decades been used by doctors and paramedics during emergency resuscitation after an opiate overdose. Following the lead of programs in Europe and the US who have successfully distributed take-home naloxone, the Overdose Prevention and Reversal Program at the Lower East Side Harm Reduction Center (LESHRC) has started providing a similar resource for opiate users in NYC. Participants in the program receive a prescription for two doses of naloxone, with refills as needed, and comprehensive training to reduce overdose risk, administer naloxone, perform rescue breathing, and call 911. As of September 2005, 204 participants have received naloxone and been trained, and 40 have revived an overdosing friend or family member. While naloxone accessibility stands as a proven life-saving measure, some opiates users at LESHRC have expressed only minimal interest in naloxone use, due to past experiences and common misconceptions. METHODS: In order to improve the naloxone distribution program two focus groups were conducted in December 2004 with 13 opiate users at LESHRC to examine knowledge about overdose and overdose prevention. The focus groups assessed participants' (i) experiences with overdose response, specifically naloxone (ii) understanding and perceptions of naloxone, (iii) comfort level with naloxone administration and (iv) feedback about increasing the visibility and desirability of the naloxone distribution program. RESULTS: Analyses suggest that there is both support for and resistance to take-home naloxone, marked by enthusiasm for its potential role in reviving an overdosing individual, numerous misconceptions and negative views of its impact and use. CONCLUSION: Focus group results will be used to increase participation in the program and reshape perceptions about naloxone among opiate users, also targeting those already prescribed naloxone to increase their comfort using it. Since NYC is advancing toward a citywide naloxone distribution program, the LESHRC program will play an important role in establishing protocol for effective and wide-reaching naloxone availability.

Journal Article↗

PubMed1996

Cocaine use and HIV disease progression among heterosexuals.

Evidence derived fromin vitro experiments would suggest that cocaine exposure may hasten the progression of HIV disease among infected individuals. Epidemiologic support for this association is equivocal at best. We examined the relationship between cocaine use and decline in CD4 cell counts over a 6-month period in a cohort of 81 heterosexually active men and women who were infected with HIV. Overall, cocaine users were 1.4 times (90% CI=1.0-2.1) more likely to experience a decline in CD4 count than were non-cocaine users. Cocaine users with a baseline CD4 count of greater than 500 cells/mm(3) were at 1.6 times (90% CI=1.2-2.3) greater risk for a CD4 decline than non-cocaine users at this baseline CD4 level. Concurrent treatment with an antiretroviral agent [AZT] modified the strength of this association, as evidenced by a cumulative incidence ratio (CIR) of 0.4 (90% CI=0.1-1.3) among AZT users and a CIR=2.2 (90% CI=1.5-3.2) among those not undergoing AZT treatment. The results of this study raise concerns about the negative effects of cocaine on people living with HIV infection, particularly those not receiving antiretroviral therapy who entered our study with a relatively intact immune system.

Journal Article↗

PubMedDate not supplied

The health planning context and its effect on a user's perceptions of software usefulness.

This article reports a health planner's experience in using program planning software and the contextual factors that influenced her perceptions. The software examined (EMPOWER) is designed to support program planning for prevention of breast cancer through mammography screening. Use by a health professional in an urban hospital was examined through a case study approach. The user was interviewed at 3, 6, and 12 months following initial use. Transcripts were coded using Roger's characteristics of an innovation as a framework for categorizing the user's perceptions. Contextual factors identified as important in influencing her perceptions were open-coded and themes identified. The user referred to three contextual factors in describing characteristics of the innovation: implementation factors, user background, and work and community environment. The successful dissemination of software will depend not only on characteristics of the innovation, but also on situational circumstances that must be changed by, or accommodated in the technology.

Attitude to Computers↗

PubMed1999

MultiMed--remote interactive medical simulation.

MultiMed is a telemedicine and tele-education project to extend access to a sophisticated medical simulation facility in Bristol. It will allow remote users to undertake simulated medical scenarios and to access a reference database, for a comprehensive remote learning experience. The first phase will focus on the area of anaesthesia and all remote users will be based in the UK.

Anesthesiology↗

PubMed2005

[Questionnaire study of general practitioners regarding experience and attitude to opioid substitution therapy].

UNLABELLED: General practitioners (GPs) in their surgeries and substitution treatment centres are the major providers of opioid maintenance treatment in a number of European countries. Although in the Czech Republic any GP has been allowed to prescribe buprenorphine (Subutex) since 2001, the opioid substitution treatment provided by primary care professionals has not been the subject of research to date. OBJECTIVE: To collect and analyze data on GPs' experience gained with opioid maintenance treatment in the Czech Reupblic, their attitudes and needs. METHOD: A structured questionnaire was distributed via the Bulletin of the Association of General Practitioners and district Association representatives. The validity of study results may be affected by a low respondence rate (10%) with 398 questionnaires only returned by mail. RESULTS: Twenty-eight (7%) GPs reported to have gained experience with buprenorphine which was most frequently prescribed in the regions with the highest prevalence of heroin users, i.e. in Prague and the Ustí nad Labem region (27% and 12%, respectively). Other regions, including wes- tern and southern Bohemia with relatively high prevalence of heroin users, showed lower buprenorphine prescription rates (0-6%). Most buprenorphine prescribers (78%) rated their experience as positive or highly positive. Availability and effectiveness were seen as the main pros of the substitution treatment. One third of the GPs who have not prescribed opioid maintenance treatment yet are considering doing so in the future. Greater awareness of drug abuse issues and availability of methodical guidance and consulting in opioid substitution treatment are going to become the most relevant factors in the future. Possible reportability of data on opioid maintenance treatment to a central registry does not seem to be a major obstacle to implementing the substitution treatment in the GPs' surgeries. Decision makers should take advantage of the GPs' potential to promote the opioid maintenance treatment in the Czech Republic.

Adult↗

PubMed2000

Peer-initiated overdose resuscitation: fellow drug users could be mobilised to implement resuscitation.

Research interviews about overdose experiences were conducted with 115 patients attending a methadone maintenance clinic in south London, UK. While almost half (49.6%) reported having experienced overdose personally (on an average of four occasions each), almost all (97.4%) reported that they had witnessed overdoses (on an average of six occasions each). This represents a total of 706 overdoses witnessed, of which 106 had resulted in fatalities. The vast majority of patients (86/97) reported that they had taken actions when they had witnessed overdoses with those acting taking an average of nearly threee different actions on the last occasion on which they had seen someone overdosing. Most respondents reported that they would be willing to act, even if they did not know the overdose victim personally and that they had not been deterred from acting by the previous response from the emergency services. Fear of punishment was not a strong deterrent from acting certainly not for this sample, with many participants also expressing an interest in expanding their repertoire of overdose interventions, for example through training in resuscitation techniques and by keeping naloxone at home for use in overdose emergency.

Journal Article↗

PubMed2000

Extending the excitation sculpting concept for selective excitation.

Nowadays, excitation sculpting is probably the most efficient way to achieve selectivity in an NMR experiment, since it associates very clean frequency selection with "user-friendliness." In the present report, it is shown that the excitation sculpting concept, originally based on a double pulse field gradient echo acting on a selected transverse magnetization, can be extended through new experiments designed to act on longitudinal magnetization. This leads to outstanding performances, especially when the transverse relaxation rate is a limiting factor as, for example, in the case of biological macromolecules. Several new sequences are proposed, aiming at the selection of magnetization aligned either/both on a transverse axis or/and on the z-axis. Their potentialities are illustrated in light of different applications including multiplet-selective excitation, band-selective excitation, and water suppression.

Animals↗

PubMed2000

2J,(3)J-HMBC: A new long-range heteronuclear shift correlation technique capable of differentiating (2)J(CH) from (3)J(CH) correlations to protonated carbons

The development of a series of new, accordion-optimized long-range heteronuclear shift correlation techniques has been reported. A further derivative of the constant time variable delay introduced in the IMPEACH-MBC experiment, a STAR (Selectively Tailored Accordion F(1) Refocusing) operator is described in the present report. Incorporation of the STAR operator with the capability of user-selected homonuclear modulation scaling as in the CIGAR-HMBC experiment, into a long-range heteronuclear shift correlation pulse sequence, (2)J,(3)J-HMBC, affords for the first time in a proton-detected experiment the means of unequivocally differentiating two-bond ((2)J(CH)) from three-bond ((3)J(CH)) long-range correlations to protonated carbons. Copyright 2000 Academic Press.

Journal Article↗

PubMed1998

Industry's perception and use of occupational exposure limits.

Market research was carried out to determine industry's perception of occupational exposure limits (OELs) and the extent to which they influence the selection of measures to control exposure. Telephone interviews were carried out with 1000 randomly selected users of chemicals, 400 from establishments with some use of chemicals and 600 from establishments with chemicals in daily use. 150 interviews were also carried out with Trade Union Health and Safety Representatives. The interviews covered basic information on chemicals used, sources of information, risk reduction measures used and understanding of COSHH and OELs. Most respondents came from firms with 10 employees or less (75%, all user group; 57%, heavy user group), closely reflecting the profile of British industry. In contrast, most (77%) Trade Union Health and Safety Representatives came from firms with at least 100 employees. Respondents in the all user group were drawn from across the whole range of industrial activity, whereas the heavy users were concentrated in manufacturing. The results showed that in making decisions on what control measures to use most users rely heavily on information from suppliers and personal experience and rather less on information from sources such as Trade Associations and HSE. Most respondents reported that steps were taken to protect employees. The use of personal protective equipment featured highly, followed by process controls. Little consideration was given to the possibility of substitution. Awareness of COSHH was limited with 65% of the all user group and 53% of the heavy user group being unaware of any legal requirements for establishments which manufacture or work with chemicals. Awareness of OELs was similarly limited with 19% of the all user group and 32% of the heavy user group having any real understanding. The results from Trade Union Representatives showed that overall they are somewhat better informed than chemical users in the small firms surveyed.

Air Pollutants, Occupational↗

PubMed2000

MATLAB and graphical user interfaces: tools for experimental management.

MATLAB is a convenient platform for the development and management of psychological experiments because of its easy-to-use programming language, sophisticated graphics features, and statistics and optimization tools. Through implementation of the Brainard-Pelli Psychophysics Toolbox, the MATLAB user gains close temporal and spatial control over the CRT, while retaining the simplicity of an interpreted language conductive to rapid program development. MATLAB's abilities can be further utilized through easily programmable graphical user interfaces (GUIs). We illustrate how a GUI can serve as a powerful and intuitive tool for organizing and controlling all aspects of a psychological experiment, including design, data collection, data analysis, and theory fitting.

Computer Graphics↗

PubMedDate not supplied

The sixth level of electronic health records: a look beyond the screen.

A recent publication details five levels of electronic health records as defined by the Medical Records Institute and notes that no computer-based patient record system from any company meets the criteria set by the Institute of Medicine. The present article calls to the attention of potential purchasers of medical record software our observation that even if a package appears to meet the abstract criteria for all five levels of electronic health records, its performance may not be satisfactory. A look beyond the user interface screen is highly recommended. Examples from our recent experience are given.

Equipment Failure↗

PubMed2001

The effect of clodronate and antioestrogens on bone loss associated with oestrogen withdrawal in postmenopausal women with breast cancer.

In this study we report bone mineral density (BMD) changes during clodronate and antioestrogen treatment in women with breast cancer having discontinued hormone replacement therapy (HRT) at the time of operation compared to women who had not used HRT immediately before the operation. 61 postmenopausal women with operable breast cancer were treated with the adjuvant antioestrogen tamoxifen 20 mg or toremifene 60 mg daily for 3 years. All patients were randomized to clodronate (1.6 g daily orally) or control groups for 3 years. 23 patients had recently (recent users) and 38 never or not for at least 1 year before operation used HRT (non-users). BMD of lumbar spine and femoral neck were measured before antiresorptive therapy (antioestrogens and clodronate) and at 1, 2, 3 and 5 years thereafter. All patients were disease-free at the time of BMD measurements. Patients who had recently used HRT had more significant bone loss as compared to HRT non-users at 3 years in lumbar spine - 3.0% vs. + 1.2% (P< 0.001), but not in femoral neck - 0.4% vs. + 1.7% (P = 0.27). Adding 3-year clodronate treatment to antioestrogen therapy improved BMD marginally at 3 years: lumbar spine + 1.0% vs. -1.7% (P = 0.01) and femoral neck + 2.4% vs. -0.4% (P = 0.12). This was also seen at 5 years of follow-up, 2 years after termination of the antiresorptive therapy: HRT recent users vs. HRT non-users in lumbar spine -6.5% vs. +0.5% (P< 0.0001) and in femoral neck -4.8% vs. -1.5% (P = 0.38); and clodronate vs. controls in lumbar spine -1.0% vs. -3.2% (P = 0.06) and in femoral neck -0.1% vs. -5.2% (P = 0.001, respectively). The type of endocrine therapy (tamoxifen and toremifene) had no significant influence on BMD changes. We conclude from this study that postmenopausal women who have recently discontinued HRT experience more rapid bone loss than HRT non-users. Neither 3-year antioestrogen therapy alone nor antioestrogen together with clodronate could totally prevent the bone loss related to HRT withdrawal in lumbar spine, even though clodronate seemed to retard it.

Aged↗