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PubMed1975

Lockheed experience in processing large data bases for its commercial information retrieval service.

The last few years have seen the emergence of the information retrieval services industry. This industry consists of three tiers: data base producers, retrieval service vendors, and information centers who service the end user. The experience of Lockheed Information Systems as a retrieval service vendor is recounted as it pertains to its system and to its relationship with the data base suppliers. Government competition is seen as a potential threat to the industry.

Computers↗
PubMed2000

An evaluation of the safety and effectiveness of telephone triage as a method of patient prioritization in an ophthalmic accident and emergency service.

Service changes in the accident and emergency service at Manchester Royal Eye Hospital in England resulted in a telephone triage-based referral service for health care professionals. It became clear that this service needed evaluation in order to assure both providers and users of the service that this referral strategy, based on experienced nurse practitioners making decisions about patient priority, was safe and effective. The evaluation was extended to encompass the other area of the service where telephone referrals tend to be directly from patients. A mixed method was used. Information gained within the telephone triage conversation was compared with a final diagnosis through retrospective analysis of secondary data; the documentation of those patients who were not given access to the service initially was followed-up to ensure that this decision was safe and a number of nurses were questioned about telephone information gathering, using partially structured interviews. The study showed that nurse practitioners within the accident and emergency service were able to elicit accurate information from the telephone triage conversation on which to base a decision about patient access in most cases (76% over the whole service). This resulted in the appropriate prioritization of patients. No patient who needed urgent access to the service was denied it. The decisions made to deny urgent appointments to a number of patients were safe in all cases. It appears that one of the problem areas in the gathering of information for prioritization purposes is in the nurses' telephone triage discussions with some, but by no means all, doctors. Some general practitioners seemed unwilling to discuss the patient and give accurate information to a nurse and this is an area which appears to need some further work.

Emergencies↗
PubMed2002

British National Health Service's and women's costs of antenatal ultrasound screening and follow-up tests.

OBJECTIVE: To estimate resource use and costs associated with routine obstetric ultrasound and follow-up tests from both the British National Health Service and women's perspectives. METHODS: Women attending Liverpool Women's Hospital (UK) in 1998 and 1999 were involved in the study. Bottom-up and top-down costings of National Health Service resources using questionnaires and diaries to record staff time associated with procedures were performed. Questionnaires were used to assess women's costs of attending for antenatal ultrasound scans. RESULTS: Routine antenatal ultrasound scans at Liverpool Women's Hospital cost the National Health Service between 14 pounds sterling and 16 pounds sterling per scan. More detailed secondary scans and other follow-up procedures cost substantially more. Costs to women, their families and their employers were estimated at between 9 pounds sterling and 15 pounds sterling per scan, depending on assumptions about the opportunity costs of time when not in paid employment and costs to employers of women who were in paid employment. CONCLUSIONS: Accurate estimates of costs to the National Health Service associated with routine antenatal ultrasound scanning are substantially lower than that cited in much of the literature. Costs to women are very similar to National Health Service costs. Economic evaluations should attempt to include costs to users of the service, particularly when the burden of cost is likely to shift.

Adult↗
PubMed1993

Clinicians' satisfaction with a hospital blood transfusion service: a marketing analysis of a monopoly supplier.

One of the objectives of the NHS reforms is to improve customer focus within the health service. In a study to assess the quality of customer service provided by the Edinburgh and South East Scotland Blood Transfusion Service a 19 item questionnaire survey of the main clinical users of the service was performed to ascertain their satisfaction, measured on a 5 point anchored scale, with important aspects of the service, including medical consultation, diagnostic services, blood and blood components or products and their delivery, and general satisfaction with the service. Of 122 clinicians in medical and surgical disciplines in five hospitals in Edinburgh, 72 (59%) replied. Fourteen (22%) indicated dissatisfaction with any aspect of the medical consultation service, owing to inadequate follow up of clinical contacts and unsatisfactory routing of incoming calls. Diagnostic services were criticised for the presentation, communication, and interpretation of results. The restricted availability of whole blood, the necessity to order platelets and plasma through the duty blood transfusion service doctor, and the use of a group and screen policy, attracted criticism from a small number of clinicians. Ten of 68 respondents expressed dissatisfaction with delivery of blood and components to the wards and theatres. The findings indicate that the clinicians served by this blood transfusion service are largely satisfied with the service. Changes are being implemented to improve reporting of laboratory results and measures taken to improve liaison with clinicians.

Attitude of Health Personnel↗
PubMed1990

Family resources and children's use of primary health care services in Finland in 1979.

The purpose of the study was to determine how children's use of primary health care services was related to family resources (socio-economic status, marital and residential stability of the family, and core/periphery dichotomy). The population consisted of a random sample of 3201 children from 15 municipalities in the province of Uudenmaan lääni in Southern Finland in 1979. Among two-parent families in the core regions total utilization of primary health care services was significantly higher among the children of workers and upper white-collar employees. Children of farmers and lower white-collar employees in the periphery exhibited low primary health care utilization. Children in upper white-collar employees' families (both two- and one-parent) in core regions frequently used private services. Among children of one-parent families, exceptionally high users of private services were children of upper white-collar mothers in core regions, and of municipal health services the children of working-class mothers in the periphery. Non-migrated children had a slight tendency to use health services more than migrated children. Differences in family resources thus cannot be ignored when children's utilization of primary health care services is studied.

Child↗
PubMed1994

Managing special education needs: helping and involving parents.

This paper reviews a period of enormous change and flux in the English education service. It notes that a number of the supports and sources of advice traditionally available to parents of young people with special educational needs and to the young people themselves are now reduced, are being changed or are in the process of being removed. It proposes a new emphasis for service professionals, administrators and the voluntary bodies working in the area of special educational needs. The central premise is that the work and role of the voluntary bodies, in supporting young people with special needs and their parents, should be welcomed and confirmed as a vital element within the educational process. A range of practical service strategies is proposed which is intended to sustain a user friendly educational service during a time of massive change. A model for confirming the potentially significant role of the voluntary bodies in this important area of educational need is offered.

Education, Special↗
PubMed1991

Children's hospitals: specialty hospitals that treat children specially.

Any reader who has children will agree that they make special patients, whether at home or in the hospital. These patients have unique requirements for love and compassionate care, and children's hospitals deliver on their promises. The well-run children's hospitals researched for this article have converted their material management operational challenges to opportunities. They have built thoughtful material management strategic plans, reorganized their support services to provide customer service to end users, and they have centered their materiel management efforts around service and quality improvement.

Child↗
PubMed1997

Paediatric utilisation of a teaching hospital and a community health centre. Predictors of level of care used by children from Khayelitsha, Cape Town.

RATIONALE: Inappropriate utilisation of hospital services for primary curative care aggravates inefficiencies and inadequacies in health care delivery. Identification of reasons for such malutilisation may assist the development of appropriate strategies for development of rationally organised primary and secondary care services that will provide improved quality of care. SUBJECTS: Children under 6 years of age living in Khayelitsha. OBJECTIVES: To ascertain: (i) the proportion of visits made to Red Cross Children's Hospital (RXH) that could be more appropriately handled at primary care level; (ii) reasons for attendance at RXH, compared with attendance at a large community health centre (Site B day hospital) in Khayelitsha; (iii) predictors of inappropriate attendance at the teaching hospital for primary care problems. METHODS: A case-referent study design was used to compare children attending RXH with children attending Site B day hospital. All care-givers attending the respective outpatient departments on 2 randomly selected days were included in the study sample. Data were collected by semi-structured interview and record review, on reasons for attendance, demographic and social variables relating to the child and care-giver, as well as clinical data on the final diagnosis contained in the patients' folders. Criteria for determining appropriateness of attendance by level of care were developed a priori via a modification of published measures. MAIN OUTCOME MEASURES: Reasons for attendance at the facility, appropriateness of the visit by level of care and predictors of inappropriate attendance at the teaching hospital. RESULTS: Sixty-nine per cent of RXH visits were identified as inappropriate for a tertiary institution. The main reasons given by care-givers for attending Site B were convenience and the prohibitive cost of travel to RXH. Mothers interviewed at RXH reported problems with failure of treatment at primary care clinics, and being turned away at Site B because of overcrowding as the main reasons for attending RXH. Attendance at RXH was predicted by: (i) children who were infants; (ii) no other domestic child care responsibilities for the care-giver; and (iii) no previous attendance documented in the hospital folder. CONCLUSION: Appropriate service utilisation by level of care needs to be improved. Users' choice of service appears to be a rational decision based on the accessibility of local primary care services and perceptions of the quality of these services. More appropriate use of primary care facilities therefore requires better access and perceived quality.

Child Health Services↗
PubMed2003

Use of self-help services and consumer satisfaction with professional mental health services.

This study tested the hypothesis that users of mental health self-help services would be more satisfied with professional mental health services than clients who did not use self-help services. A survey was administered to 311 clients of professional mental health services, 151 (49 percent) of whom were users of self-help services. A multiple regression model showed that the use of self-help services was associated with greater satisfaction with professional mental health services. This finding provides support for the idea that the use of self-help services encourages appropriate use of professional services. The study provided evidence that self-help and traditional mental health services can function complementarily rather than in competition with one another.

Adult↗
PubMedDate not supplied

[Knowledge and attitudes regarding family clinics on the part of women who use or do not use them].

Thanks to large civil participation and to the women's movement in 1975 a law has been approved that institutes family health clinics. This law is dedicated in particular to health and general services for women and to family planning. The Hygiene Department of University of Perugia has studied during this time: the family health clinics (FHC) activity in order to determine how well it is meeting the institutional aims. The knowledge and the attitudes of women with respect their use of FHC which have been projected onto the community. Health Education has a very important role because it is quite often basis for acceptance of FHC by women. The identification of all aspects of cultural resistance is very important. To this point a research project has been completed. The focal point of this research concerns women and their ability to profit from available information, as well as their attitudes and evaluation of the FCH. This study has been using a representative sample of Umbrian women, aged 16-50 ys old, at March 1987; the sampling method was of two stage. On the whole 1647 observations have been made by means of a mail questionnaire. The responders were very low (about 25%), so the results obtained must be considered with extreme caution. Generally there is a positive opinion on family health clinic: women are linked to a service of the community. They express satisfaction with the service. They express opinions on both positive and negative aspects. Even if the first approach is generally determined by a gynecological visit, the users redefine the service in a less ambulatory manner and into a more consultative one. In fact, users consider the FHC as a reference for women's problems. They underline the lack of sexual and health consulting service. There is demand for counseling for infancy problems, sterility, health education and sexual education. Even the non-users have a sufficiently clear idea of the family health clinics. Non-users view the FHC as a service for women's problems as well as relationship problems.

Adolescent↗
PubMed2005

Social networks among users of mental health day care--predictors of social contacts and confiding relationships.

BACKGROUND: The social networks of people with mental illness have received much attention, but users of day care services have rarely been considered. METHODS: Users of day hospitals and day centres were surveyed cross-sectionally. Demographic and illness factors were tested for associations with network size, while intrinsic relationship factors were tested for association with confiding in a network member. RESULTS: There was some evidence that a longer duration of contact with services, more unmet needs, working, living in supported accommodation and needing help with psychotic symptoms were associated with having a larger network, while a longer duration of contact was associated with having more confidantes. Day centre users confided in people who were more likely to be friends or neighbours than professionals, and who were more likely to be the same sex. CONCLUSION: For people in day care, the stereotype that people with longer-term mental health problems are socially isolated is contradicted by this study. The limited role of professionals in providing confiding relationships is striking.

Adult↗
PubMed2006

Identification of similar regions of protein structures using integrated sequence and structure analysis tools.

BACKGROUND: Understanding protein function from its structure is a challenging problem. Sequence based approaches for finding homology have broad use for annotation of both structure and function. 3D structural information of protein domains and their interactions provide a complementary view to structure function relationships to sequence information. We have developed a web site http://www.sblest.org/ and an API of web services that enables users to submit protein structures and identify statistically significant neighbors and the underlying structural environments that make that match using a suite of sequence and structure analysis tools. To do this, we have integrated S-BLEST, PSI-BLAST and HMMer based superfamily predictions to give a unique integrated view to prediction of SCOP superfamilies, EC number, and GO term, as well as identification of the protein structural environments that are associated with that prediction. Additionally, we have extended UCSF Chimera and PyMOL to support our web services, so that users can characterize their own proteins of interest. RESULTS: Users are able to submit their own queries or use a structure already in the PDB. Currently the databases that a user can query include the popular structural datasets ASTRAL 40 v1.69, ASTRAL 95 v1.69, CLUSTER50, CLUSTER70 and CLUSTER90 and PDBSELECT25. The results can be downloaded directly from the site and include function prediction, analysis of the most conserved environments and automated annotation of query proteins. These results reflect both the hits found with PSI-BLAST, HMMer and with S-BLEST. We have evaluated how well annotation transfer can be performed on SCOP ID's, Gene Ontology (GO) ID's and EC Numbers. The method is very efficient and totally automated, generally taking around fifteen minutes for a 400 residue protein. CONCLUSION: With structural genomics initiatives determining structures with little, if any, functional characterization, development of protein structure and function analysis tools are a necessary endeavor. We have developed a useful application towards a solution to this problem using common structural and sequence based analysis tools. These approaches are able to find statistically significant environments in a database of protein structure, and the method is able to quantify how closely associated each environment is to a predicted functional annotation.

Computational Biology↗
PubMed2005

Social support networks and medical service use among HIV-positive injection drug users: implications to intervention.

The study used network analysis to identify forms and sources of social support associated with a medical services use among a medically underserved population living with HIV/AIDS. Participants were African American former or current injection drug users (n=295; 34% female, 45% current drug users and 17% AIDS diagnosed). Outcomes were access to the same medical provider, use of outpatient services and emergency room (ER) use with or without subsequent hospitalization. Controlling for AIDS diagnosis, insurance, current drug use and gender, access to the same medical care provider was associated with more females in one's support network and more network sources of emotional support, financial support and instrumental assistance. Adjusting for confounders, outpatient service use was associated with more female support network members and more sources of emotional support. Controlling for participants' drug use and insurance, sub-optimal emergency department use was associated with greater number of active drug users in one's support network. Contrary to other study findings, having a supportive sex partner was associated with lower access to medical care, and kin support was not associated with medical service use. Results indicate that specific sources and forms of social support had differential influences on the sample's utilization of medical services. The findings suggest that promoting HIV-positive African American injection drug users' support network functioning may help improve HIV medical services utilization among this medically underserved population.

Adult↗
PubMedDate not supplied

[Prenatal care at the first level of care: characteristics of providers that affect users' satisfaction].

OBJECTIVE: To assess the satisfaction level attained by prenatal care users in primary health services in Mexico, and to compare the level of satisfaction according to characteristics of the provider and the service. MATERIAL AND METHODS: A cross-sectional survey was conducted to analyze data from 217 care provider-user pairs. Interviews were carried out in 95 primary care units in eight Mexican states. The information was collected through a) direct observation of the medical encounter, b) interviews with providers and users, and c) a questionnaire and knowledge examination to providers. Users' satisfaction was analyzed according to providers' clinical ability and the treatment received during the visit. Summary and dispersion measures of the main issues were calculated, as well as bivariate and trends analysis. RESULTS: User satisfaction in prenatal care is associated with the treatment received during the visit and to the waiting time before being attended, but not with the provider's clinical ability, nor with his or her age or gender. The treatment received during the visit was also associated with the user's socioeconomic level, where the poorer users received the worst treatment. CONCLUSIONS: Health services should assess users' satisfaction according with the type of medical encounter, particularly where resources are scarce and where economic disparities are present. In such cases, the provision of healthcare services may intensify inequality, with greater impact on the poorest. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Attitude of Health Personnel↗
PubMed2003

Divided care and the Third Way: user involvement in statutory and voluntary sector cancer services.

In health care, as in much of the public sphere, the voluntary sector is playing an increasingly large role in the funding, provision and delivery of services and nowhere is this more apparent than in cancer care. Simultaneously the growth of privatisation, marketisation and consumerism has engendered a rise in the promotion of 'user involvement' in health care. These changes in the organisation and delivery of health care, in part inspired by the 'Third Way' and the promotion of public and citizen participation, are particularly apparent in the British National Health Service. This paper presents initial findings from a three-year study of user involvement in cancer services. Using both case study and survey data, we explore the variation in the definition, aims, usefulness and mechanisms for involving users in the evaluation and development of cancer services across three Health Authorities in South West England. The findings have important implications for understanding shifts in power, autonomy and responsibility between patients, carers, clinicians and health service managers. The absence of any common definition of user involvement or its purpose underlines the limited trust between the different actors in the system and highlights the potentially negative impact of a Third Way health service.

Health Priorities↗
PubMed2002

The differential effectiveness of psychosocial and biogenetic causal explanations in reducing negative attitudes toward "mental illness".

Given the apparent failure of the "mental illness is an illness like any other" approach to reducing negative stereotypes of people with mental health problems, the differential effects of biogenetic and psychosocial explanations of psychiatric symptoms were evaluated. Attitude measures were administered to young New Zealand adults before and after a video portraying a young man with psychotic symptoms followed by either biogenetic or psychosocial explanations. Consistent with previous studies, the "medical model" approach significantly increased perceptions of dangerousness and unpredictability. Following the psychosocial explanation there was a slight but statistically insignificant improvement in attitudes. Participants who knew users of psychiatric services, or who had used services themselves, had more positive attitudes than other participants. It is recommended that destigmatization programs minimize efforts to persuade the public that mental health problems are biogenetic illnesses, and focus instead on increasing exposure to users of mental health services. Further research is required to determine whether such exposure should include life histories, so as to highlight the psychosocial causes of mental health problems.

Adult↗
PubMed1999

Choosing and paying for care.

This paper presents data from before and after implementation of the 1990 NHS and Community Care Act in 1993. It shows the low proportions of the population who are covered by private health insurance and draws attention to the fact that, although some older people have considered private health insurance, few are covered. Comparing data for people aged <65 with those aged >65, the paper explores the preferred sources of help in a range of situations. The findings show that in most instances, statutory services are preferred. Data for older people aged >80 are presented comparing findings from 1990/91 and 1995, which show that use of services for which charges have been introduced appear to have fallen. Low take-up of dental and optician services are identified. The implications of the findings for social policy are considered and it is suggested: that insurance cover for long-term care should be organized at a national level; that greater attention should be given to service preferences of users and potential users; and, that the effectiveness of various health and social care services should be evaluated.

Journal Article↗