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PubMed2006

Web tutorials: bibliographic instruction in a new medium.

Libraries are adding electronic resources of all kinds at an increasing pace to provide service to users outside the library and around the world. To meet this new demand, libraries are turning more and more to the use of online tutorials as a valuable means of providing instruction on how to access and use important resources. This article describes the Health Sciences Library and Biocommunications Center's work and experiences while creating tutorials, the ideas used, and ways the work was evaluated.

Databases, Bibliographic↗

PubMed2004

Pediatric emergency department outreach: solving medical problems or revealing community solutions?

Low-acuity (LA) use of emergency departments (EDs) is often viewed as misuse or abuse. We designed a program to help users access services more efficiently. Community health workers (CHWs) functioned as health educators, screeners, and liaisons to care. A participatory curriculum emphasized medical problems. Qualitative ethnographic methods were used for formative evaluation. Ninety families received regular visits from CHWs. Original system-oriented objectives and methods did not fit community needs. Instead, information was gathered regarding service utilization patterns: (1) families mistrusted primary and preventive care, reporting frequent discrimination and humiliation; (2) a primarily biomedical prioritization did not match families' need hierarchies; (3) complex demands of poverty made other uses of the system challenging; (4) primary care services were frequently avoided; and (5) the ED was often preferred. Intangible psychosocial factors and practical complexities of poverty were powerful promoters of LA visits. Families were creative strategists, viewing LA visits as rational use, not misuse, of a challenging system.

Baltimore↗

PubMed1990

Knowledge and information about drugs in Australia.

This article uses a national population survey conducted in 1988 to examine drug information needs within the Australian population. The analysis concentrates on three types of informational needs--knowledge and contact with drug services, the nature of the drug information sought, and the sources of drug information. The results show that almost half of the respondents in the survey considered that they had an adequate amount of information about drugs and there were generally high levels of factual knowledge about the drug and alcohol services available in the community. Knowledge of drug services was found to be unrelated to the need for information, although high levels of knowledge did correlate with a willingness to use a variety of medical, welfare, and social support services to obtain information. The data indicated that contact significantly correlated with both a desire for information and a willingness to consult a variety of services. Finally, users of all types of drugs reported higher levels of knowledge, with users of illicit drugs, in particular, expressing a greater desire for information about all types of drugs and an increased willingness to use a variety of welfare and social support agencies.

Adolescent↗

PubMed1975

Psychiatric evaluation services to court referred drug users.

This paper reports on the description and outcome of one hundred youthful drug abusers referred from family court for psychiatric evaluation and treatment recommendation. The average referral, both male and female, was a 16-year-old white Catholic from a middle class background who was diagnosed as having a personality disorder. Significantly more males than females showed pathology in early childhood such as behavior problems in school and hyperactivity. Follow-up data collected up to 6 months after evaluation and treatment recommendation indicated that approximately half of the clients showed improvement in terms of work and/or school adjustment, social relations, and drug use.

Achievement↗

PubMed1997

Patients with mental illness in primary health care. A long-term follow-up of health care utilization and contact patterns with psychiatric care.

OBJECTIVE: Long-term follow-up of the use of health care services in patients with a mental illness identified in primary care. A 10-year follow-up of all health care utilization in five 1-year cohorts of patients with a mental illness identified in primary health care services of a Swedish health care district. PATIENTS: 1167 (408 males, 759 females) with mental illness. RESULTS: A total of 27.1% of the patients were in contact with psychiatric services during follow-up. The strongest associations with contact with psychiatric services concerned age (younger) and diagnosis (dependence, affective psychosis). Patients with a diagnosis of psychosis had the highest utilization of psychiatric services. Patients in contact with psychiatric care had a higher consumption of primary health care and of somatic outpatient and inpatient care. A subgroup identified as high consumers consumed 44% of the total health care resources used by the cohort. CONCLUSION: The use of health care services was very skewed. Patients in contact with psychiatric services were more frequent users of other medical services.

Adolescent↗

PubMed2005

[Risk factors for heavy burden among family caregivers in a rural town in Hokkaido].

OBJECTIVE: The present study was conducted in order to investigate risk factors for heavy burden of family caregivers. STUDY DESIGN: Cross-sectional study. PARTICIPANTS: 51 pairs of the frail elderly and their family caregivers in one town in Hokkaido. RESULTS: Compared to those with a lighter burden, family caregivers with heavier burden looked after the frail elderly with more behavior disturbances due to dementia. They cared for the elderly longer and had less time to go out without accompanying their charges than less burdened caregivers. On the other hand, the elderly had similar activities of daily living and degree of need of care between the two groups. In addition, physical caring time did not differ between the two groups. These findings suggest that the psychological burden may be more important than the physical burden. In addition, caregivers used only 30-40% of services they had the right to use with long-term care insurance. These findings suggest that more convenient services for users should be provided.

Aged↗

PubMed1997

Stress in the community: teaching relaxation.

In this article, the author describes a project designed to offer an alternative to traditional treatment for stress. The author discusses the techniques taught to clients to help them cope with stress and the evaluation of the service for users.

Adaptation, Psychological↗

PubMed2006

User satisfaction with a constipation service: a comparative audit.

Chronic constipation in children affects their quality of life and can have far reaching consequences, causing low self-esteem in children and family conflict (McGinley 2001). A review of outcomes following the establishment of a new constipation service showed significant improvements in outcomes and in the level of support provided to families. To obtain a more in depth picture of effectiveness, quantitative findings were supplemented with the views of 16 children and families who use the service. Families generally understood the condition and were attempting to make lifestyle changes. They appreciated the education and support offered by the service: for many it was the first time that they had been given effective treatment for what was often a long term problem. Although the existing service is effective, further development could help prevent constipation, improve early intervention and prevent the need for secondary referrals.

Aftercare↗

PubMed1991

Experts, lies and stereotypes.

In the second of two articles in involving mental health users in service development, Vivien Lindow discusses the Catch-22 of stigma and representativeness.

Attitude of Health Personnel↗

PubMed1995

Clinical engineering helps reduce equipment costs.

Clinical engineering involves, among other activities, managing equipment repair and maintenance activities, assessing technology needs and potential equipment acquisitions, training users, negotiating service contracts, and optimizing patient-care equipment utilization. Effective clinical engineering programs can help healthcare organizations reduce the high cost of acquiring and maintaining patient care equipment.

Biomedical Engineering↗

PubMed1987

Hospitals can attract women through education.

Hospitals are responding to women's demands for information about healthcare by instituting educational programs specifically for women. To plan such programs, the first step is to establish the major goal--whether to attract new market segments or to better serve existing users of services. It is possible to accomplish both, but they may require different approaches in terms of the program's location, time, presenters, topics, and promotion. In addition to attracting an audience, these programs also can build an image and promote utilization of services. Women who hear or read of the programs will get the impression the hospital cares and is enlightened about women. Targeted segments can be established by factors such as age, geography, and employment status, and programs can be set up to meet the specific needs of each segment. The program planners must resist the urge to tell women what the planners want them to know; instead, planners should learn what the women want to know. The programs also should rely on research that deals specifically with women, instead of information applicable to all people, since that information is usually based on the study of men only. Once the program has been presented, its effectiveness can be measured through random telephone or mail surveys to determine whether the target market has been reached.

Female↗

PubMed1986

Changes in distribution of Medicare expenditures among aged enrollees, 1969-82.

In this article, we examined the concentration of Medicare expenditures among the aged for 1969, 1975, and 1982 to determine if expenditures have become more concentrated among a few heavy users of service over time. Despite an increase in reimbursements for the aged from $6.0 billion in 1969 to $41.8 billion in 1982, the distribution of those expenses remained remarkably stable, with a slight lessening in the concentration of reimbursements in 1982. Patterns were similar for both Part A (hospital insurance) and Part B (supplementary medical insurance) services. The concentration of expenditures was much greater among survivors than among people who died in both 1975 and 1982, with little change in the distribution of expenditures within either group.

Aged↗

PubMed1998

The need for a holistic view of telemedicine, focused on patients and society as prime stakeholders.

Telemedicine provides the scope to remove the barrier of distance from delivery of health care. In so doing it has the potential to strengthen primary care and local health delivery, and to optimise the use of secondary and tertiary specialist resources. However, it can have disbenefits and perverse effects which are as yet inadequately addressed. Development of telemedicine to date has been led by new technological opportunities, linked to clinical interests. Whilst not inappropriate, this alone is not adequate. All health care activities should be to promote health and treat ill-health, and therefore the interests of the consumer and of society should predominate. More complete research and policy analysis of telemedicine are therefore needed. This paper argues for a more holistic and integrated view of telemedicine to be taken, to ensure that technology is harnessed to meet need. To this end, it puts telemedicine into the overall context of health care interests, and describes methodologies to assess patient attitudes and societal priorities. Given the need to avoid the unanticipated adverse effects which have bedevilled other new health care technologies, and the particular risks of uncontrolled consultations and commerce across national boundaries, the paper goes on to advocate routine use of integrated risk analysis of telemedicine applications at research and policy levels. The need for an effects-orientated analytic framework, and for international policy collaboration to protect users of services available by global telecommunications, is identified.

Health Policy↗

PubMed1999

A comparative analysis of individuals with spinal cord injury who differ in unplanned utilization of health services.

The purpose of this descriptive study is to describe the profile of individuals with spinal cord injuries (SCI) who frequently use health care services in an unplanned manner so that nursing interventions could be designed to decrease utilization. The medical records of 78 subjects with SCI were reviewed for demographic and injury-related variables, comorbid health conditions, discharge disposition, and health care utilization for five years. Based on the rate of unplanned utilization of health care services, three groups of users were identified: non-user, low-user, and high-user groups. Results indicated that high users, compared to non-users and low users, had a higher substance-use rate, a higher unemployment rate at the time of the most recent health care visit, and more violent causes of their SCI. Findings suggest four clinically meaningful trends that have practical implications for nurses related to marital status, substance use, employment status, and etiology of injury. Results of this study laid the foundation for future research aimed at devising a more in-depth risk profile of high users of health care services in the SCI population.

Adult↗

PubMed2000

The futility of common firewall policies: an experimental demonstration.

Many healthcare organizations utilize network "firewalls" to protect their networks from being accessed by unauthorized external entities. These same firewalls are also often configured to deny access to certain external services from within the internal network. The latter policy can be subverted through a "protocol tunneling" strategy, which has been implemented as a set of programs called "Firehole." Organizations should be aware of this potential weakness in their network security designs. Policies that deny external services to users should be carefully evaluated in light of clearly defined organizational goals.

Computer Communication Networks↗

PubMed2003

Initial defaulting in the National Tuberculosis Programme in Ho Chi Minh City, Vietnam: a survey of extent, reasons and alternative actions taken following default.

SETTING: Ho Chi Minh City, Vietnam. AIM: To determine the extent of initial default in the NTP, the reasons for initial default, health seeking after initial default and treatment received at other health facilities. METHOD: Questionnaire-based interviews of patients who were diagnosed with sputum-positive TB in the NTP during 2000 and who did not register for treatment in the NTP. RESULTS: The initial default rate was 8.3%; 79% gave reasons related to the NTP working procedures or treatment strategy, while 17.5% gave reasons related to insufficient knowledge among patients about TB and/or the need for treatment. Sixty-five per cent had been treated with anti-tuberculosis drugs at other health facilities after default, of which 74% had been treated at fully private facilities. CONCLUSION: Initial default is mainly caused by some patients' negative perceptions of working procedures and/or treatment strategy in the NTP. The majority of these patients are treated in private clinics after default from the NTP. The NTP needs to improve patients' perceptions of the treatment strategy and develop more user-friendly services that enable more patients to access treatment and reduce the risk of patients receiving substandard treatment in the private sector.

Adolescent↗

PubMed1992

Network information security in a phase III Integrated Academic Information Management System (IAIMS).

The developing Integrated Academic Information System (IAIMS) at Columbia-Presbyterian Medical Center provides data sharing links between two separate corporate entities, namely Columbia University Medical School and The Presbyterian Hospital, using a network-based architecture. Multiple database servers with heterogeneous user authentication protocols are linked to this network. "One-stop information shopping" implies one log-on procedure per session, not separate log-on and log-off procedures for each server or application used during a session. These circumstances provide challenges at the policy and technical levels to data security at the network level and insuring smooth information access for end users of these network-based services. Five activities being conducted as part of our security project are described: (1) policy development; (2) an authentication server for the network; (3) Kerberos as a tool for providing mutual authentication, encryption, and time stamping of authentication messages; (4) a prototype interface using Kerberos services to authenticate users accessing a network database server; and (5) a Kerberized electronic signature.

Computer Communication Networks↗

PubMed2006

Success and failure factors in the regional health information system design process--results from a constructive evaluation study.

OBJECTIVES: To identify success and failure factors in the design process of a regional health information system. METHODS: A constructive evaluation study including interviews, observations, usability study and document analysis. RESULTS: Modelling was found to be a key element for the successful implementation of a health information system. The developed service chain model helped to define use cases and to implement seamless service chains. User participation in the design process was a success factor resulting in good user acceptance and signs of positive impacts on work practices. Evaluation study also helped system developers to guide the system's further development. An important failure factor identified was the lack of semantic interoperability of the system components. CONCLUSIONS: The results emphasize the socio-technical nature of health information systems. The starting point for development should be thorough insight into the health care work practices where the information systems are to be used. Successful system design should start from modelling of work processes, data and information flows and definition of concepts and their relations. Health informatics as a scientific discipline provides theories and models for the design and development process.

Attitude to Computers↗