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PubMedDate not supplied

Two tools for well-being: health systems and communities.

Medical systems and associative communities are two distinctive social tools. To promote health, tools of community are more significant than system tools. Medical systems were created to serve many needs efficiently and to produce standardized procedures and outcome. Clients are a necessary component of a medical system. Associative communities are formed with the active consent of the people they serve and require citizens rather than clients. If the promotion of health is the goal, the medical system is limited in what it can achieve by the nature of its design. Only when systems recognize the need for community building and work together with associations, focusing on citizens' capacities rather than clients' deficiencies, can health promotion be successful.

Awareness↗

PubMed1994

A teaching tool for patients receiving continuous i.v. infusion recombinant interleukin-2 therapy.

PURPOSE/OBJECTIVES: To present a tool developed to facilitate education of patients and families undergoing continuous i.v. therapy with interleukin-2 (IL-2). DATA SOURCES: Published articles, book chapters, authors' clinical experience. DATA SYNTHESIS: Topics covered in the teaching tool include development of IL-2, immune functioning, common side effects, side effect management, and when to contact healthcare providers. CONCLUSIONS: Well-received by patients, families, and healthcare providers who reviewed the material. IMPLICATIONS FOR NURSING PRACTICE: Use of a written patient education tool enables nurses to effectively teach patients with efficient use of nursing time.

Carcinoma, Renal Cell↗

PubMed1994

An object-oriented tool for the generation and management of multimedia patient folders.

Computer-based patient folders are evolving from the simple reproduction of traditional paper documents toward active tools, able to support the whole diagnostic and therapeutic process. The advent of multimediality has given emphasys to the idea of computerized folder, i.e. a collection of heterogeneous kinds of documents pertaining different media. In this paper we present a tool implementing generation and management of multimedia patient folders showing its architecture and functionalities and the innovative interaction paradigms adopted. The tool realized allows medical users to choose the concepts desired in their target application and generates a customized patient folder management system by means of a friendly interface and without the need of a programming language. The system automatically created can be effectively employed for reporting and storing clinical cases.

Computer Systems↗

PubMedDate not supplied

Preceptor selection and evaluation: a tool for educators and managers.

The preceptor concept has been cited extensively in the literature, although few measurable tools for preceptor identification, selection, and evaluation have been documented. This article describes a tool designed to assist in the selection of unit preceptors. The tool also provides an evaluation method for preceptors and identifies areas for future preceptor development when used on an annual basis.

Education, Nursing, Continuing↗

PubMed1993

Ergonomic hand tool design.

The use of ergonomic design and appropriate selection of hand tools can reduce exposure to cumulative trauma. The design and principles presented in this article should help reduce the biomechanical stresses to the workers' hands, arms, and shoulders. Remember, tissues of each individual have a threshold of resistance, and if that threshold is crossed too many times by a defective or ill-fitting tool, pathologic changes can occur. The proper tool design, rotating work schedules, work pacing, scheduling, and exercise programs can, in combination, improve productivity and promote human wellness.

Arm Injuries↗

PubMed1995

The reliability of pressure sore risk-assessment tools.

Regular use of a risk-assessment tool may help increase and maintain staff awareness of pressure sore risk. All staff need to be educated in the use of the selected tool, to ensure reliability between users. A tool's threshold score should not be presumed appropriate in all patient areas. Care should be taken when using these scores to allocate preventive resources.

Humans↗

PubMed1995

Business modeling tools for managing decision support systems.

We sought to investigate the role of business modeling tools in facilitating the implementation of interactive decision support systems (DSS) for laboratory test ordering. We have recently shown that Ripple Down Rules (RDR), a new strategy for building expert systems (ES), enables institutions to build DSS maintained by local experts without knowledge engineering support. While DSS hold great promise for improving health outcomes by providing doctors with timely access to care guidelines, implementation will require careful planning and change management. The Situated, Strategic, and AI-Enhanced method was used to define and assess a DSS-driven process change. DECmodelTM, a graphical business modeling application, was used to build representations of current (paper-based) and future (ES-supported) test ordering environments. Models described both the interactions between new processes and the impact on healthcare quality of ES-supported DSS. Models were able to represent the key processes involved in test ordering and the impact of DSS. Users could interact with the model to examine the time and cost implications of the transition from current to future states. The level of detail in which processes could be examined was readily controlled by the user. We have shown that graphical business modeling applications are useful tools for enabling institutions to view the impact of DSS. Accuracy of models should be maximized in workshops involving key management personnel. Whilst the impact of modeling on the cost and quality of DSS implementation remains to be established, we believe these tools are valuable for institutions planning to align DSS technologies to their service needs.

Australia↗

PubMed1995

Multi-national, multi-lingual, multi-professional CATs: (Curriculum Analysis Tools).

A consortium of dental schools and allied dental programs was established in 1991 with the expressed purpose of creating a curriculum database program that was end-user modifiable [1]. In April of 1994, a beta version (Beta 2.5 written in FoxPro(TM) 2.5) of the software CATs, an acronym for Curriculum Analysis Tools, was released for use by over 30 of the consortium's 60 member institutions, while the remainder either waited for the Macintosh (TM) or Windows (TM) versions of the program or were simply not ready to begin an institutional curriculum analysis project. Shortly after this release, the design specifications were rewritten based on a thorough critique of the Beta 2.5 design and coding structures and user feedback. The result was Beta 3.0 which has been designed to accommodate any health professions curriculum, in any country that uses English or French as one of its languages. Given the program's extensive use of screen generation tools, it was quite easy to offer screen displays in a second language. As more languages become available as part of the Unified Medical Language System, used to document curriculum content, the program's design will allow their incorporation. When the software arrives at a new institution, the choice of language and health profession will have been preselected, leaving the Curriculum Database Manager to identify the country where the member institution is located. With these 'macro' end-user decisions completed, the database manager can turn to a more specific set of end-user questions including: 1) will the curriculum view selected for analysis be created by the course directors (provider entry of structured course outlines) or by the students (consumer entry of class session summaries)?; 2) which elements within the provided course outline or class session modules will be used?; 3) which, if any, internal curriculum validation measures will be included?; and 4) which, if any, external validation measures will be included. External measures can include accreditation standards, entry-level practitioner competencies, an index of learning behaviors, an index of discipline integration, or others defined by the institution. When data entry, which is secure to the course level, is complete users may choose to browse a variety of graphic representations of their curriculum, or either preview or print a variety of reports that offer more detail about the content and adequacy of their curriculum. The progress of all data entry can be monitored by the database manager over the course of an academic year, and all reports contain extensive missing data reports to ensure that the user knows whether they are studying complete or partial data. Institutions using the beta version of the program have reported considerable satisfaction with its functionality and have also offered a variety of design and interface enhancements. The anticipated release date for Curriculum Analysis Tools (CATs) is the first quarter of 1995.

Curriculum↗

PubMed1995

Image-oriented rule generating tool for medical knowledge base.

This paper describes an automatic programming tool for the end users in the medical knowledge representation. When end users work with the rule generating tool (RGT) that we have designed, they can represent an idea using an Image-oriented interface such as a picture, movie, audio reference or two dimensional bar code. Such representations can be valuable tools for medical study, diagnosis, decision making and treatment monitoring to supplement the expertise of medical personnel. The RGT will automatically generate rules in the logic programming language Prolog and then add them to the knowledge base.

Algorithms↗

PubMed1996

A self-care assessment tool (SCAT) for persons with a spinal cord injury: an expanded abstract.

The purpose of this study was to develop a reliable and valid tool that assesses the cognitive and functional skills needed for self-care in persons with spinal cord injury (SCI). The Self-Care Assessment Tool (SCAT) assesses cognitive and functional skills in eight self-care areas: bathing/grooming, nutritional management, medications, mobility/transfers/safety, skin management, bladder management, bowel management and dressing. The tool was carefully developed and has demonstrated content validity. Using two samples of veterans seen in the SCI clinics of two Southern Veterans Affairs Medical Centers, n = 13 and n = 15, interrater reliabilities computed by Pearson product moment correlations for the cognitive, functional and total scores ranged from .69 to .94. Test-retest reliabilities using Pearson product moment correlations for the cognitive, functional and total scores of two groups (n = 14 and n = 15) ranged from -.06 to .86. Regarding predictive validity, R2 was found to be .61 to .90 for the cognitive, functional and total scores. Although continued reliability and validity studies are needed, the SCAT has potential to measure patient rehabilitation outcomes, to evaluate nursing care approaches and to serve as a quality assurance indicator for nursing care.

Activities of Daily Living↗

PubMed1996

Development of the Woman Abuse Screening Tool for use in family practice.

BACKGROUND: This study developed a screening tool for use by family physicians to identify and assess women patients experiencing emotional and/or physical abuse by their partner. METHODS: An initial set of eight questions developed for the Woman Abuse Screening Tool (WAST) was completed by both abused and non-abused women. Participants were also asked to indicate their comfort in answering the questions in both research and family practice contexts. They also completed the Abuse Risk Inventory and a demographic questionnaire. Analysis of the WAST included 1) standard assessment of the validity and reliability of the measure and 2) examination of the efficacy of further reducing the number of questions on the WAST for screening purposes. RESULTS: The final samples of abused (n = 24) and non-abused women (n = 24) differed significantly on a number of demographic and abuse variables. After eliminating one of the original items, a strong single factor structure was identified for the WAST that accounted for 85% of the total variance in responses to the WAST items. The WAST was found to be a highly reliable measure; coefficient alpha was estimated at.95. The scale also demonstrated construct and discriminant validity. The abused women reported being less comfortable responding to the WAST questions, in both the research and family practice contexts, than the non-abused women. The two WAST questions the abused women reported being most comfortable with were used to construct the WAST-Short for initial screening purposes. The WAST-Short correctly classified 100% of the non-abused women and 91.7% of the abused women. CONCLUSIONS: The WAST demonstrated good reliability and validity and discriminated between abused and non-abused women. Development of the WAST-Short provides physicians with a relatively unobtrusive screening tool for assessing abuse. The use of additional WAST questions can be used to further explore the possibility that a woman patient is experiencing abuse by her partner. Further study includes field testing the WAST in the family practice setting.

Battered Women↗

PubMed1996

Using molecular tools for diagnosis in veterinary parasitology.

The development of molecular biology has made available tools that identify parasites which are important in veterinary parasitology. PCR (polymerase chain reaction) is the most frequently used tool. Target sequences are ribosomal DNA and RNA as well as fragments derived from RAPD (random amplified polymorphic DNA). The most studied protozoan genera have been: Eimeria, Babesia, Theileria, Trypanosoma and Cryptosporidium. Trichinella species and ruminant Trichostrongylid parasites have been the most investigated helminths. The use of molecular tools for identification in veterinary parasitology, however, remains a research technique rather than one that is currently used in the field for diagnostic purposes.

Animals↗

PubMed1996

A pain management documentation tool.

PURPOSE/OBJECTIVES: To describe the development, implementation, and evaluation of a tool to standardize assessment, monitoring, management, and documentation of acute and chronic pain in hospitalized patients. DATA SOURCES: A multidisciplinary hospital committee, nursing staff, a pain consultant, published standards, and hospital standards. DATA SYNTHESIS: A comprehensive pain flow sheet and pain protocol was developed to assess, monitor, document, and evaluate clients at risk for or with actual pain. The tool was designed to assess and document acute and chronic pain in patients with cancer. CONCLUSIONS: Based on an initial review of quality assurance indicators, the tool has demonstrated increased consistency in documentation of pain management activities. IMPLICATIONS FOR NURSING PRACTICE: The use of a pain assessment and management flow sheet with a pain protocol provides an organized, consistent approach that maximizes quality, cost-effective care.

Analgesics↗

PubMed1996

Assessment of a knowledge-acquisition tool for writing Medical Logic Modules in the Arden Syntax.

We have created a tool that allows users unfamiliar with the Arden Syntax and our underlying database to create Medical Logic Modules (MLMs). In a study of this tool (N 16), subjects found it easy to use (mean score - 4.69 on a scale of 1-5, 5 being best). Each subject created 3 MLMs of varying complexity following a protocol. On average, subjects required 312, 308 and 318 seconds, respectively, to complete each MLM. Comparison of clinicians to non-clinicians and those with to those without knowledge of Arden showed no significant difference. Of the 48 MLMs, 47 compiled and executed with appropriate output. Independent manual review of the MLM correlated well and found few errors. We conclude that our tool is easily used by inexperienced persons to write MLMs in the Arden Syntax.

Artificial Intelligence↗

PubMed1996

Integrated stand for vibration and ergonomic investigations of hand-held impact tools.

This paper presents an integrated test stand for hand-held impact tools (rnu) enabling complex vibration and ergonomic investigations according to the standards ISO 8662, EN 28662 and EU directives. The stand testing range has been established basing on the system investigations (1) concerning all the factors harmful to the operator's health existing on the work stands equipped with rnu. The parameters of rnu supply which should be monitored and recorded during investigations have been also established. Course of investigations is controlled by a computer provided with the original SYS-DEA program (7). The integrated stand is equipped with a Quality Assurance System of investigations making impossible measurement and recording of erroneous signals. Simultaneous acquisition, measurement and recording of fourteen signals are done during the course of investigations. This paper contains a short description of stand design and the results of comparative investigations conducted with use of new generation of pneumatic hammers as a source adapted for man-operator requirements (5). Comparative investigations showed that the mechanical part of the stand simulates dynamic conditions of a man-operator and rnu investigations without presence of operators are possible. Moreover, the stand makes possible very good repeatability of tool fastening and supplying. Vibration spectrum correlation coefficient for particular fastening in the stand is in the range: 0.967-0.994 and is decidedly higher than the operator's pushing force. Vibration investigations revealed design drawbacks of the impact energy absorber made according to the standards SO 8662 and EN 28662 that should be eliminated. Results of the rnu investigations attained in the integrated stand make possible a complex evaluation of tested tools not only in the range of vibration and noise but also in the range of the most important ergonomic parameters connected with for example operator's physical overload and issue of certificates by certifying units.

Equipment Design↗

PubMed1995

Knowledge-acquisition tools for medical knowledge-based systems.

Knowledge-based systems (KBS) have been proposed to solve a large variety of medical problems. A strategic issue for KBS development and maintenance are the efforts required for both knowledge engineers and domain experts. The proposed solution is building efficient knowledge acquisition (KA) tools. This paper presents a set of KA tools we are developing within a European Project called GAMES II. They have been designed after the formulation of an epistemological model of medical reasoning. The main goal is that of developing a computational framework which allows knowledge engineers and domain experts to interact cooperatively in developing a medical KBS. To this aim, a set of reusable software components is highly recommended. Their design was facilitated by the development of a methodology for KBS construction. It views this process as comprising two activities: the tailoring of the epistemological model to the specific medical task to be executed and the subsequent translation of this model into a computational architecture so that the connections between computational structures and their knowledge level counterparts are maintained. The KA tools we developed are illustrated taking examples from the behavior of a KBS we are building for the management of children with acute myeloid leukemia.

Algorithms↗

PubMed1995

Determination of "vibration emission values" for fastener driving tools (nailers).

Hand-held fastener driving tools (nailers, staplers, pinners) differ considerably from other vibrating tools in terms of mode of vibration. For satisfying the requirements of the Machinery Directive 89/392/EEC, including also the compulsory declaration of a characteristic vibration value, appropriate measuring methods had to be developed. The measuring method elaborated by the BIA and standardised under ISO 8662-11 takes into account existing regulations and, in particular, specifications applying to the standardised vibration measuring instrument. Apart from aspects related to measuring and working conditions, a particular problem consisted of excluding vibrations which are recorded although not generated by the tool. In addition, the use of vibration measuring instruments according to ISO 8041 was required, too. For these reasons a release cycle time was defined which is both a representative measure for the daily vibration dose and a compromise in terms of measuring accuracy. The paper presents first results obtained on the basis of the standard. It also gives an overview of the state of the art by indicating the load range as a function of the fastener size.

Acceleration↗

PubMed1997

Prevalence of abnormal glucose tolerance in Khon Kaen Province and validity of urine stick and fasting blood sugar as screening tools.

Three hundred and fifty-five individuals, 152 males and 203 females, aged between 30 and 74 years, were randomly selected in a two stage selection process from rural communities in three districts of Khon Kaen Province, Northeast Thailand. The prevalence of impaired glucose tolerance (IGT) and non-insulin dependent diabetes mellitus (NIDDM) in the rural area of Northeast Thailand were measured. In addition, the validity of the urine stick and fasting blood sugar as screening tools against the two hours glucose loading test as golden standard were determined. The survey was conducted in July 1995. The glucose loading test was performed on 277 individuals. IGT and NIDDM were classified according to current World Health Organization suggestions. Prevalence rates for IGT were 18.1 per cent and for NIDDM 11.9 per cent. No difference was found between males and females, also when controlled for age. NIDDM prevalence increased with age but IGT rates already were high in the younger age groups. This finding suggests that IGT precedes NIDDM in Thailand. The validity of the urine stick as a screening tool in communities was insufficient, with a sensitivity of less than 20 per cent. When using fasting blood sugar as a screening test, the sensitivity was close to 44 per cent and the specificity 90 per cent. It is concluded that the urine stick is not a useful screening tool and the method of using blood sugar concentrations for screening have to be improved before it can be applied within communities.

Adult↗