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PubMed2001

A collaborative model to guide program development and change: involving the users.

Organizations have different structures and cultures within which to conduct their business activities. Ranging from autocratic and rigid styles to more laissez-faire models, this report describes the program development and change model used by the Missouri Kidney Program (MoKP). Two examples illustrate how involvement of renal community professional staff and MoKP program staff in instituting and modifying program elements help to build in acceptance from the very beginning, avoiding start-up difficulties and miscues on implementation. Examples cited are the inception of the Nutritional Supplement Program and ongoing modification of the Centralized Drug Program's formulary. The Missouri Kidney Program uses a participatory approach to involve the users of service in program design and modification and historically has used this sort of approach with relative success over time.

Humans↗
PubMedDate not supplied

African-American injection drug users: tensions and barriers in HIV/AIDS prevention.

This exploratory study utilized a focus group methodology to explore tensions and barriers in HIV/AIDS prevention among African-American injection drug users. Participants discussed HIV infection risks, national/community HIV prevention effectiveness, prevention barriers, ideas on barrier removal, and the tensions which exist between users and the larger African-American community. Recognizing the inevitability of continued drug use for many injectors, participants requested basic harm-reduction supplies including condoms, needle exchange programs, additional drug user treatment services, and the use of culturally- and gender-matched peer-led prevention and treatment outreach. Preliminary recommendations are made for consideration in HIV/AIDS prevention among African-American IDUs.

Adult↗
PubMed2001

Gender differences in the perception of drug user treatment: assessing drug user treatment for youthful offenders.

The present study sought to determine whether gender-specific differences existed in the perception of drug user treatment services delivered at a residential substance misuse treatment program operated by a large youth correctional agency in the western United States. Hypothesized gender differences in perceptions of treatment services and treatment-related needs were confirmed in a number of areas such as treatment engagement, counseling needs, and postrelease concerns. Findings of this exploratory study underscore the need to consider gender-specific issues in correctional substance misuse treatment for young offenders.

Adolescent↗
PubMed2003

The European Bioinformatics Institute web site: a new view.

SUMMARY: The European Bioinformatics Institute (EBI), and outstation of the European Molecular Biology laboratory, has revamped its web site for the second time since 1997 in order to address increased user demand as well as establishing better uniformity and easier accessibility for the ever growing number of users and services it offers to the community. A GRID-like hardware infrastructure has been put in place to provide round the clock services in a redundant and reliable fashion. AVAILABILITY: http://www.ebi.ac.uk/

Academies and Institutes↗
PubMed2005

PRODISTIN Web Site: a tool for the functional classification of proteins from interaction networks.

UNLABELLED: The PRODISTIN Web Site is a web service allowing users to functionally classify genes/proteins from any type of interaction network. The resulting computation provides a classification tree in which (1) genes/proteins are clustered according to the identity of their interaction partners and (2) functional classes are delineated in the tree using the Biological Process Gene Ontology annotations. AVAILABILITY: The PRODISTIN Web Site is freely accessible at http://gin.univ-mrs.fr/webdistin

Algorithms↗
PubMed2003

MGAlignIt: A web service for the alignment of mRNA/EST and genomic sequences.

Splicing is a biological phenomenon that removes the non-coding sequence from the transcripts to produce a mature transcript suitable for translation. To study this phenomenon, information on the intron-exon arrangement of a gene is essential, usually obtained by aligning mRNA/EST sequences to their cognate genomic sequences. MGAlign is a novel, rapid, memory efficient and practical method for aligning mRNA/EST and genome sequences. We present here a freely available web service, MGAlignIt (http://origin.bic.nus.edu.sg/mgalign/mgalignit), based on MGAlign. Besides the alignment itself, this web service allows users to effectively visualize the alignment in a graphical manner and to perform limited analysis on the alignment output. The server also permits the alignment to be saved in several forms, both graphical and text, suitable for further processing and analysis by other programs.

Algorithms↗
PubMed2000

Current issues in rehabilitation outcome measurement: implications for audiological rehabilitation.

OBJECTIVE: This paper will describe several key issues current in rehabilitation outcome measurement that should be considered in the establishment or choice of any new outcome measurement system or tools. DESIGN: The paper is a concept piece based on a review of literature rather than on experimental design. RESULTS: Social and political forces of the 1990s are affecting the need for outcome measurement and management: consumerism, or empowerment of the end user of services; the global Internet and information age; and the pervasiveness of the concept of quality improvement. In this context, several underlying concepts are important in effective outcome management approaches. Rehabilitation's focus on the person served provides a frame for measurement. Measurement in terms of the domains of the World Health Organization's International Classification of Impairments, Activities and Participation reflects meaningful dimensions of rehabilitation for people with hearing loss. Activities in the arena of rehabilitation performance indicator development are summarized and challenges in developing outcome management systems are discussed. CONCLUSIONS: The paper proposes that choice is a key outcome of interest in rehabilitation. Persons served in audiological rehabilitation and providers alike can benefit from systematic outcome measurement, but more can be learned about outcomes. Attention to consistent and uniform outcome measurement in audiological rehabilitation is consistent with the trends in the rehabilitation community at large.

Community Health Services↗
PubMed1976

Consumer participation and social accountability.

Consumer participation in the planning and management of health care programs is prescribed as a method for increasing provider responsiveness to the goals and needs of users of services. However, issues related to the nature of mandates to implement consumer participation has not had the impact on policy development proposed for it. While structural changes can be identified which might enhance the consumer role in decision making, it will also be necessary for the consumer sector to develop a strategy which will prompt major rather than incremental movement.

Community Participation↗
PubMed2001

Requests for electroencephalography in a district general hospital: retrospective and prospective audit.

OBJECTIVES: To determine the number of inappropriate requests for electroencephalography (EEG) and whether guidelines on use could reduce this number. DESIGN: Audit with retrospective and prospective components. SETTING: EEG department in district general hospital and centre for neurology and neurosurgery. PARTICIPANTS: Retrospective: 368 at the general hospital and 143 patients at the neurology centre. Prospective: 241 patients undergoing EEG at the general hospital. INTERVENTIONS: Guidelines for EEG issued to users of service at the general hospital. OUTCOMES: Retrospective: differences in requesting practice, result in different clinical scenarios, relative roles of procedure, clinical acumen in establishing diagnosis, usefulness of procedure. Prospective: change of requesting practice, impact on use. RESULTS: There were considerable differences in requesting practice. Non-specialists seem to use EEG as a diagnostic tool, especially in patients with "funny turns," when it is much more likely to yield potentially misleading than clinically useful information. The overall proportion of procedures considered to influence management, to be justifiable, and to be inappropriate were 16% (59), 28.3% (104), and 55.7% (205), respectively. In the prospective study the total number of requests was significantly reduced (chi(2)=33.85, df=5, P<0.0001), mainly because of fewer requests in patients with non-specific "funny turns" (chi(2)=21.90, df=6, P=0.0013). There was a concomitant change in the usefulness of EEG (chi(2 )=26.99, df=2, P<0.0001). CONCLUSIONS: This original audit informed clinical practice and had potential benefits for patients, clinicians, and provision of service. Systematic replication of this project, possibly on a regional basis, could result in financial savings, which would allow development of accessible local neurophysiology services.

Electroencephalography↗
PubMed2003

Public opinion on systems for feeding back views to the National Health Service.

OBJECTIVES: To explore public opinions about different systems for feeding back views about health services to the National Health Service. DESIGN: Questionnaire survey. SETTING: NHS Grampian, Scotland, UK. PARTICIPANTS: A random sample of 10 000 adults registered with a general practitioner in Grampian was invited to opt in to the study; 2449 were sent questionnaires. OUTCOME MEASURES: Opinions about different feedback mechanisms and their likely effectiveness in three scenarios; reasons for preferring particular mechanisms. RESULTS: Of 1951 respondents, over 80% thought patient representatives would be a good way for people to pass on their ideas about the NHS and would help to improve it. Patient representatives were the most widely preferred course of action for two out of three scenarios. People explained their preferences for particular feedback systems mainly in terms of their ease of use, the perception that they would be listened to, and the likelihood of anything being done about what they said. However, people varied in their judgements about the likely effectiveness of different feedback systems. Preferences for particular systems varied according to the types of situation considered. Some people are reluctant to approach clinical staff with concerns about healthcare quality. A substantial minority have no confidence that their concerns would be listened to or acted upon, however they were expressed. CONCLUSION: The "patient representative" function has substantial popular support and could facilitate local learning and action to improve the quality of health services from users' perspectives. Feedback systems must demonstrate their effectiveness if they are to gain and retain public confidence.

Adult↗
PubMed1999

A tuberculin screening and isoniazid preventive therapy program in an inner-city population.

As tuberculosis transmission decreases, case rates decline and an increasing proportion of cases arises from the pool of persons with latent infection. Elimination of tuberculosis will require preventing disease from developing in infected persons. From 1994 to 1996 the Atlanta TB Prevention Coalition conducted a community-based tuberculin screening and isoniazid preventive therapy project among high-risk inner-city residents of Atlanta, Georgia. We established screening centers in outpatient waiting areas of the public hospital serving inner-city residents, the city jail, clinics serving the homeless, and with outreach teams in neighborhoods frequented by drug users. All services were provided free. A total of 7,246 persons participated in tuberculin testing; 4,701 (65%) adhered with skin test reading, 809 (17%) had a positive test, 409 (50%) fit current guidelines for isoniazid preventive therapy, 84 (20%) we intended to treat completed therapy. The major limitations of this community-based tuberculin screening and preventive therapy project were the low proportion of infected individuals who were eligible for isoniazid preventive therapy and the poor adherence with a complete regimen among those we intended to treat. For community-based programs to be efficacious, preventive therapy regimens that are of shorter duration and safe for older persons will need to be implemented.

Adolescent↗
PubMed2005

Approaching the taxonomic affiliation of unidentified sequences in public databases--an example from the mycorrhizal fungi.

BACKGROUND: During the last few years, DNA sequence analysis has become one of the primary means of taxonomic identification of species, particularly so for species that are minute or otherwise lack distinct, readily obtainable morphological characters. Although the number of sequences available for comparison in public databases such as GenBank increases exponentially, only a minuscule fraction of all organisms have been sequenced, leaving taxon sampling a momentous problem for sequence-based taxonomic identification. When querying GenBank with a set of unidentified sequences, a considerable proportion typically lack fully identified matches, forming an ever-mounting pile of sequences that the researcher will have to monitor manually in the hope that new, clarifying sequences have been submitted by other researchers. To alleviate these concerns, a project to automatically monitor select unidentified sequences in GenBank for taxonomic progress through repeated local BLAST searches was initiated. Mycorrhizal fungi--a field where species identification often is prohibitively complex--and the much used ITS locus were chosen as test bed. RESULTS: A Perl script package called emerencia is presented. On a regular basis, it downloads select sequences from GenBank, separates the identified sequences from those insufficiently identified, and performs BLAST searches between these two datasets, storing all results in an SQL database. On the accompanying web-service http://emerencia.math.chalmers.se, users can monitor the taxonomic progress of insufficiently identified sequences over time, either through active searches or by signing up for e-mail notification upon disclosure of better matches. Other search categories, such as listing all insufficiently identified sequences (and their present best fully identified matches) publication-wise, are also available. DISCUSSION: The ever-increasing use of DNA sequences for identification purposes largely falls back on the assumption that public sequence databases contain a thorough sampling of taxonomically well-annotated sequences. Taxonomy, held by some to be an old-fashioned trade, has accordingly never been more important. emerencia does not automate the taxonomic process, but it does allow researchers to focus their efforts elsewhere than countless manual BLAST runs and arduous sieving of BLAST hit lists. The emerencia system is available on an open source basis for local installation with any organism and gene group as targets.

Classification↗
PubMed2002

Advance directives for patients compulsorily admitted to hospital with serious mental illness. Randomised controlled trial.

BACKGROUND: An advance directive is a statement of a person's preferences for treatment, should he or she lose capacity to make treatment decisions in the future. AIMS: To evaluate whether use of advance directives by patients with mental illness leads to lower rates of compulsory readmission to hospital. METHOD: In a randomised controlled trial in two psychiatric services in inner London, 156 in-patients about to be discharged from compulsory treatment under the Mental Health Act were recruited. The trial compared usual psychiatric care with usual care plus the completion of an advance directive. The primary outcome was the rate of compulsory readmission. RESULTS: Fifteen patients (19%) in the intervention group and 16 (21%) in the control group were readmitted compulsorily within 1 year of discharge. There was no difference in the numbers of compulsory readmissions, numbers of patients readmitted voluntarily, days spent in hospital or satisfaction with psychiatric services. CONCLUSIONS: Users' advance instruction directives had little observable impact on the outcome of care at 12 months.

Adult↗
PubMed2002

Telehealth for older patients: the Hong Kong experience.

We studied the feasibility, acceptability and cost-effectiveness of using telemedicine to provide geriatric services to residents of nursing homes. A local 200-bed nursing home supported by the community geriatric assessment team (CGAT) participated in a one-year study, during which videoconferencing was used to replace conventional outreach or clinic-based geriatric care. The feasibility of telemedicine was evaluated by participating specialists in a total of 1001 consultations. Other outcome measures included productivity gains, utilization of hospital emergency and inpatient services, and user satisfaction. Telemedicine was adequate for patient care in 60-99% of cases in seven different disciplines. The CGAT was able serve more patients and see them earlier and more frequently. Telemedicine was cheaper than conventional care, and well accepted by health-care professionals as well as clients. Substantial savings were achieved in the study period through a 9% reduction in visits to the hospital emergency department and 11% fewer hospital bed-days. Telemedicine was a feasible means of care delivery to a nursing home and resulted in enhanced productivity and cost-savings. Linking more such institutions to care providers would further increase cost-effectiveness.

Journal Article↗
PubMed2003

Assessing the effects of substance abuse among applicants for TANF benefits: the outcome of a demonstration project in Florida.

This paper examines an attempt by the State of Florida to devise a mechanism for determining the level of drug use among TANF recipients and to determine the extent to which such use affects employment, earnings and use of government services by TANF beneficiaries. Data from tests administered by substance abuse testing providers were combined with information from Medicaid, Food Stamp, cash assistance and Unemployment Insurance files to examine differences between the two groups. The findings suggest that the procedures employed by the State of Florida did not produce reliable estimates of the level of drug use among TANF beneficiaries. The data did show very small differences in employment, earnings, and use of government services between individuals who tested positively and those who tested negatively for substance abuse. In addition, evidence is presented that suggests that there is very little difference in employment, earnings and use of government services between users of different kinds of drugs.

Employment↗
PubMed2002

Utilization of preventive health services by HIV-seronegative injection drug users.

Little is known about the use of preventive health services by HIV-seronegative IDUs. This study examines screening and preventive health services use by two populations of HIV-seronegative IDUs recruited from a needle exchange program and methadone program. We found high rates of HIV and tuberculin skin testing in the past year as well as tetanus vaccination among both groups of IDUs. Hepatitis B and C testing was significantly higher in the methadone group than the needle exchange group. Syphilis testing and pneumovax administration was disappointingly low in both groups. Given the burden of disease among IDUs, our findings suggest the need for a distinct set of testing and vaccination guidelines for the HIV-seronegative IDU population.

AIDS Serodiagnosis↗
PubMed2001

Lucretia's view: an interview with Lucretia W. McClure about medical reference through the years, February 25, 2000. Interview by Nancy W. Clemmons.

Lucretia W. McClure is one of the most respected figures in the field of medical librarianship. During an interview, she reminisces about important events and changes in librarians' work, users, and services over the past thirty-five years. She also gives her perspective about the impact of computer technology on reference services. Finally, she urges reference librarians to take action to shape their future.

Computer Systems↗