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PubMedDate not supplied

Discussion of generic and disease-specific outcome tools for patients in cardiac rehabilitation.

Morbidity and mortality alone are not sufficient outcome measures in evaluating the effectiveness of interventions aimed at controlling or reducing complications of coronary heart disease. Outcomes are considered to be indicators of the quality of care. As a result, the selection of interventions, treatments, and reimbursement for services has become outcome driven. The purpose of this article is to discuss generic and disease-specific health-related quality of life tools and how to select appropriate tools for measuring long-term outcomes of cardiac rehabilitation. Choosing the appropriate tools to evaluate outcomes is critical for evaluation of patient progress and quality of life and for the success of cardiac rehabilitation programs.

Coronary Disease↗

PubMed2000

High standards. The formidable task of adopting HL7 standards is easier with the right tools.

PROBLEM: The hospital needed a strategy to integrate the HL7 standard into its facility. Because HL7 is flexible and subject to many interpretations, speaking HL7 is not a simple turnkey process. SOLUTION: Full HL7 functionality was achieved systematically and incrementally with the installation of an interface engine plus HL7 tools with end-point communication simulation. RESULTS: HL7 messaging simulation tools let technicians deliver better interfaces with fewer errors for less money. KEYS TO SUCCESS: A robust interface engine and third-party tools can lead the way for successful adoption of the protocol.

California↗

PubMed2000

New diagnostic tools for tuberculosis.

Rapid and accurate diagnosis of symptomatic patients is a cornerstone of global tuberculosis control strategies. Remarkable progress has recently been made, upgrading the speed and quality of mycobacteriology diagnostic services in industrialized countries, but for most of the world where TB is a large public health burden those gains are still unrealized. Deficiencies in current case-finding tools in disease endemic countries have made it difficult to ensure access to good diagnostics at all health service levels, leaving many patients undiagnosed. Additionally, in well-established TB control programs where diagnostic access has been ensured, efforts to interrupt disease transmission have been hampered by the insensitivity and late detection of smear microscopy. Fortunately, technical progress in diagnostics is resulting in a number of improved tools, including some appropriate for low-income settings. Important work remains, however, before new diagnostic tools can be meaningfully integrated into national TB control programs of high-burden countries and before TB control strategies can take them into account. The design and quality of clinical trials evaluating new diagnostics must be improved, clinical and laboratory services that would allow rapid response to test results need to be enhanced, and basic and operational research to appraise the impact and cost-effectiveness of new diagnostic technologies must be carried out. This paper describes some of the recent advances in TB diagnostic technologies and puts them into perspective for global tuberculosis control.

Bacterial Typing Techniques↗

PubMed2000

Novel techniques, standardization tools to enhance reliability of acoustic rhinometry measurements.

Acoustic rhinometry measurements are influenced by factors related to subject posture, breathing, inclination and positioning of the wavetube, leaks and distortion at the nostril-nose adapter connection and ambient noise. We present simple techniques to control these errors. Thus, gel on contoured nose adapters, shadow tracing to maintain posture, laser homing for wavetube alignment, are all integrated into a practical scheme that is easy to implement and causes minimum discomfort to subjects. Repeatability improved to below 3% coefficient of variation (CV) in non decongested subjects when trained operators used all the techniques together viz. gel on nose adaptors, shadow tracing, laser homing. In a factorial experiment, repeated measurements were made on subjects over two consecutive days with operator training and standardization tools as variables. An analysis of variance identified the most important factors to be gel on contoured nose adapters, operator training and control of breathing. With gel, the mean CV between readings was 5.8%, measurement time 30.3 seconds. The tools, especially gel and shadow tracing, helped untrained operators achieve performance levels that were more comparable with trained operators. Reproducible curves could be taken rapidly. Thus a significant difference of 31.2 seconds between untrained and trained operators reduced to 12.6 seconds using tools. These techniques significantly improve the reliability, speed and ease of doing repeated acoustic rhinometry measurements and thus the quality of data generated in nasal studies.

Acoustics↗

PubMed2001

Web-based surgical educational tools.

This paper describes work being undertaken as part of the WebSET (Web-based Standard Educational Tools) project. The project is producing a standardised suite of interactive three-dimensional educational tools, delivered across the WWW. The major focus will be the use of open technology and standards, and the production of learning components that can be used as building blocks for further development in a wide range of application areas. Two learning disciplines have been selected for the development of the WebSET tools: surgical training, and physiological education. A high quality consortium from across Europe has been assembled with complementary skills in the technologies needed by the project. The project is partly funded by the European Commission.

Curriculum↗

PubMed2001

CASE tools and UML: state of the ART.

With increasing need for automated tools to assist complex systems development, software design methods are becoming popular. This article analyzes the state of art in computer-aided software engineering (CASE) tools and unified modeling language (UML), focusing on their evolution, merits, and industry usage. It identifies managerial issues for the tools' adoption and recommends an action plan to select and implement them. While CASE and UML offer inherent advantages like cheaper, shorter, and efficient development cycles, they suffer from poor user satisfaction. The critical success factors for their implementation include, among others, management and staff commitment, proper corporate infrastructure, and user training.

Computer-Aided Design↗

PubMed2001

A preliminary report on the Chinese Cancer Pain Assessment Tool (CCPAT): reliability and validity.

BACKGROUND: This study was to establish the validity and reliability of the Chinese Cancer Pain Assessment Tool (CCPAT) for Chinese patients with cancer pain in Hong Kong. METHODS: It was a quasi-experimental study. The CCPAT was tested for its reliability and validity by 26 cancer pain patients and 26 chronic non-cancer pain patients. McGill Pain Questionnaire (MPQ), with its established reliability and validity, was used as the criterion tool for comparison. RESULTS: An internal consistency of 0.88 and the inter-rater reliability of 0.96 were obtained for the CCPAT. The Spearman's Rho correlations between the functional and emotional dimensions of the CCPAT and the present pain intensity of the MPQ positively correlated. This indicated a satisfactory concurrent validity. Discriminant validity was performed with MANOVA. The CCPAT was able to predict 80.8% of the subjects correctly as cancer pain patient from the cancer pain group. CONCLUSIONS: The constructed CCPAT is a valid and reliable cancer pain assessment tool in a Chinese context. The developed CCPAT is the first of its kind for the Chinese community in Hong Kong. It is anticipated that the results can provide the health care professionals with the best possible instrument and indicator. The CCPAT also lays the theoretical construct for the professionals with a better understanding of the experience of cancer pain from a multidimensional perspective.

Adult↗

PubMed2001

Operating space diagrams: a tool for designers of wastewater treatment plants.

Recent years have seen the introduction of new and varied designs of activated sludge plants. With increasing needs for higher efficiencies and lower costs, the possibility of a plant that operates more effectively has created the need for tools that can be used to evaluate and compare designs at the design stage. One such tool is the operating space diagram. It is the aim of this paper to present this tool and demonstrate its application and relevance to design using a simple case study. In the case study, use of the operating space diagram suggested changes in design that would improve the flexibility of the process. It also was useful for designing suitable control strategies.

Computer Simulation↗

PubMed2002

Gone fishing: tool use in animals.

Chimpanzees impress and fascinate us with their use of tools, including twigs to 'fish' for termites and leaves to soak up liquids. But there are many intriguing examples of tool use described across the animal kingdom. Ants use grain to carry honey, and elephants can grip fly switches in their prehensile trunks. Even animals without limbs may use tools.

Animals↗

PubMed2002

Professional perceptions about home safety: cross-national validation of the Home Falls and Accidents Screening Tool (HOME FAST).

The Home Falls and Accidents Screening Tool (HOME FAST) was developed to measure the risk of older people falling within their home environment. If this tool is to be effective, the underlying dimensions perceived by potential raters when using the HOME FAST need to be consistent with the purpose of the tool. The content validation process undertaken to evaluate the HOME FAST and a method to develop a home safety score are described. Experts in home safety assessment were recruited from the British Association of Occupational Therapy, the Chartered Society of Physiotherapists, and the Royal College of Nursing in the United Kingdom. Participants rated each HOME FAST item using a Thurstone technique format. Each item was weighted according to the level of perceived falls risk each expert attributed to the home safety item. Principal components factor analysis identified a two-factor structure interpreted as environment and function underlying the HOME FAST. Results indicated that no item should be deleted from the checklist. Weights were calculated for each item to generate an overall hazard score. Some differences in responses to the degree of risk associated with home safety items were noted between the professional groups. The HOME FAST has captured highly relevant home safety items considered by an expert panel and measures a domain applicable to home safety and falls risk.

Accidental Falls↗

PubMed2002

Research-tool patents: issues for health in the developing world.

The patent system is now reaching into the tools of medical research, including gene sequences themselves. Many of the new patents can potentially preempt large areas of medical research and lay down legal barriers to the development of a broad category of products. Researchers must therefore consider redesigning their research to avoid use of patented techniques, or expending the effort to obtain licences from those who hold the patents. Even if total licence fees can be kept low, there are enormous negotiation costs, and one "hold-out" may be enough to lead to project cancellation. This is making it more difficult to conduct research within the developed world, and poses important questions for the future of medical research for the benefit of the developing world. Probably the most important implication for health in the developing world is the possible general slowing down and complication of medical research. To the extent that these patents do slow down research, they weaken the contribution of the global research community to the creation and application of medical technology for the benefit of developing nations. The patents may also complicate the granting of concessional prices to developing nations - for pharmaceutical firms that seek to offer a concessional price may have to negotiate arrangements with research-tool firms, which may lose royalties as a result. Three kinds of response are plausible. One is to develop a broad or global licence to permit the patented technologies to be used for important applications in the developing world. The second is to change technical patent law doctrines. Such changes could be implemented in developed and developing nations and could be quite helpful while remaining consistent with TRIPS. The third is to negotiate specific licence arrangements, under which specific research tools are used on an agreed basis for specific applications. These negotiations are difficult and expensive, requiring both scientific and legal skills. But they will be an unavoidable part of international medical research.

Developing Countries↗

PubMedDate not supplied

Handheld tools assess medical necessity at the point of care.

An emerging strategy to manage financial risk in clinical practice is to involve the physician at the point of care. Using handheld technology, encounter-specific information along with medical necessity policy can be presented to physicians allowing them to integrate it into their medical decision-making process. Three different strategies are discussed: reference books or paper encounter forms, electronic reference tools, and integrated process tools. The electronic reference tool strategy was evaluated and showed a return on investment exceeding 1200% due to reduced overhead costs associated with rework of claim errors.

Computers, Handheld↗

PubMed2001

Control of mechanical viroid transmission by the disinfection of tables and tools.

Viroids are of practical importance as the cause of several economically significant infectious diseases. Potato spindle tuber viroid (PSTVd) causes severe yield losses in several crops, because the pathogen spreads fast within the culture. Viroids are small molecules, a few hundred nucleotides long, with a high degree of secondary structure. They do not code for any polypeptides and replicate independently of any associated plant virus. Viroids are readily transmitted by contaminated tools and tables. Furthermore PSTVd is transmitted through the pollen and true seed and can remain its infectious activity in seed for long periods. Vector transmission of PSTVd was reported to occur at low frequency. However, the mechanical transmission is the predominant factor and in this case we discuss the efficient disinfection of tools and tables as a main prophylactic trail to avoid viroid transmission. In previous studies we have tested the efficiency of several disinfectants to eliminate virus contamination. This paper demonstrates the efficient disinfection of MENNO-Florades (Menno-Chemie-GmbH, Norderstedt, Germany. A selection of different concentrations of the disinfectant and various times of incubation were applied in regard to practical use. The tests were confirmed by biological assays using suitable indicator plants, tissue print hybridization, gel electrophoresis and by nucleic acid hybridization. It was shown that PSTVd was eliminated when using the determined combination: 2% of the disinfectant while incubating for one minute or alternative 3%, 30 seconds. The possibility of viroid inactivation by a chemical method of disinfection--while plants are not affected--opens a new perspective to control viroid transmission via tools and tables.

Agriculture↗

PubMed2002

Towards elicitation of users requirements for hospital information system: from a care process modelling technique to a web based collaborative tool.

Growing attention is being given to the use of process modeling methodology for user requirements elicitation. In the analysis phase of hospital information systems, the usefulness of care-process models has been investigated to evaluate the conceptual applicability and practical understandability by clinical staff and members of users teams. Nevertheless, there still remains a gap between users and analysts in their mutual ability to share conceptual views and vocabulary, keeping the meaning of clinical context while providing elements for analysis. One of the solutions for filling this gap is to consider the process model itself in the role of a hub as a centralized means of facilitating communication between team members. Starting with a robust and descriptive technique for process modeling called IDEF0/SADT, we refined the basic data model by extracting concepts from ISO 9000 process analysis and from enterprise ontology. We defined a web-based architecture to serve as a collaborative tool and implemented it using an object-oriented database. The prospects of such a tool are discussed notably regarding to its ability to generate data dictionaries and to be used as a navigation tool through the medium of hospital-wide documentation.

Health Personnel↗

PubMed2002

Ultrasound is not a useful screening tool for acute acalculous cholecystitis in critically ill trauma patients.

Acute acalculous cholecystitis remains a diagnostic challenge in critically ill trauma patients. Laboratory studies are nonspecific and associated injuries or mental status changes may mask clinical signs and symptoms. We conducted a retrospective study to assess the utility of ultrasound in the diagnosis of acute acalculous cholecystitis. We hypothesized that ultrasound is inadequate as a screening tool for acute acalculous cholecystitis. The abdominal ultrasounds of all patients undergoing evaluation for acute acalculous cholecystitis in a 40-month period at our Level I trauma center were reviewed. Thickened gallbladder wall, pericholecystic fluid and emphysematous gallbladder were considered positive sonographic criteria. Sludge, cholelithiasis, and hydrops were considered suggestive. Patients who did not undergo cholecystectomy had their gallbladders evaluated either during subsequent laparotomy or at autopsy or they were discharged from the hospital without need for intervention. Sixty-two patients were included. Twenty-one patients underwent cholecystectomy for presumed acute acalculous cholecystitis. The data revealed a sensitivity of 30 per cent (6/20) and a specificity of 93 per cent (39/42) for ultrasound evaluation. Twenty patients had subsequent hepatobiliary scans [hepato-iminodiacetic acid (HIDA)] with a sensitivity of 100 per cent (12/12) and specificity of 88 per cent (7/8). Our data do not support ultrasound as a reliable routine screening tool for acute acalculous cholecystitis. Despite its convenience as a bedside procedure ultrasound has insufficient sensitivity to justify its use and a more sensitive diagnostic tool should be used.

Acute Disease↗

PubMed2002

An assessment tool for the older person with spinal cord injury.

Normal aging changes intensify the chronic problems that are experienced by individuals with spinal cord injury (SCI). These changes place them at greater risk for developing vital systems failure and functional impairments, which if unrecognized, may lead to institutionalization or death. Understanding the trajectory of aging, and its impact on structure and function, is paramount in caring for individuals with SCI. Moreover, trends in health care toward capitation, managed care systems, and shifts to outpatient care portend a delivery system with more limited resources and greater restrictions (Lubitz, Greenberg, Gorina, Wartzman, & Gibson, 2001; National Institute of Aging, 2000). These trends potentially compromise health care access, quality, and cost for at-risk populations, especially for individuals aging with an SCI. Therefore, it behooves SCI nurses to develop a comprehensive approach to assess individuals who have chronic and debilitating injuries such as SCI. More importantly, assessing these individuals will require SCI nurses to adapt current tools that will aid in this endeavor and perhaps create new ones that will reflect the magnitude of SCI presentations and care. Employing the nursing process, SCI nurses will need to gather data from a myriad of sources. The first important step is establishing a baseline. Using a functional health pattern tool (FHPT) developed by Gordon (1987), and adapted from the North American Nursing Diagnosis Association (1987), is one such method of constructing a database and formulating diagnoses (Gordon, 1994). The FHPT provides a holistic view of individuals and families in any practice setting and it can be easily adapted to specialty areas within nursing. Therefore its application to both SCI and aging is fitting (Popkess-Vawter, 1997). These authors adapted the FHPT format to create a tool that will make it more reflective of changes that occur in individuals who have SCI and are aging.

Aged↗

PubMedDate not supplied

An assessment tool for screening ROP in the preterm infant.

An increased incidence of retinopathy of prematurity (ROP) parallels the increased incidence of viable births at earlier gestational ages. However, advancements in laser therapy can treat ROP and ultimately prevent blindness. This paper describes the development, implementation, and evaluation of a tool that consistently documents ROP assessments by medical staff, as well as pertinent medical history necessary to safely manage this critical population. The assessment tool was designed for an outpatient ophthalmology clinic. The outpatient population included all infants delivered at or transferred to the neonatal intensive care unit of a large university hospital located in the Midwestern United States. The infants were considered at risk for ROP if they weighed less than 1500 grams or if they had a gestational age of less than or equal to 34 weeks. At any given time, the outpatient clinic manages from 50 to 70 infants. Implementation of the tool increased consistency in documentation by medical staff and guided the initial assessment for nursing and technical staff members.

Humans↗

PubMed2002

[Health Geographic Information System (HGIS)--a tool for health planning and epidemiology].

The development of the Health Geographic Information System (HGIS) concept, associated to the wide availability of adapted software applications, has offered an invaluable tool to Public Health Professionals. However its use is still too often limited to the graphic presentation of data or to structural planning, neglecting its main advantages. The HGIS has proven to be a potent tool for risk assessment, decision making, intervention evaluation and health planning. In spite of all the obstacles, the transformation of geographic information systems (GIS) into an epidemiological tool adapted to the health system (HGIS) can now be done in a relatively short span of time, with a minimal investment in terms of budget and manpower. The use of an outsourcing policy enables to limit the operational running costs in health organizations such as the Health Ministry, Hospitals or Sick Funds.

Epidemiologic Methods↗