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At least 145 records · Page 8Linked to original sources

PubMed2001

Simultaneous development and implementation of the children's rehabilitation activities profile: a communication instrument for pediatric rehabilitation.

PURPOSE: To describe the methods used for the development and implementation of the Rehabilitation Activities Profile for Children (Children's RAP), an instrument to structure information for team conferences. METHODS: Our strategy consisted of nine steps: (1) survey in clinical practice; (2) literature search; (3) formation of a national study group; (4) development of specifications and a national draft; (5) development of local drafts; (6) integration of local drafts; (7) consultation of users and experts; (8) national conference; and (9) assessment of user experience. RESULTS: The final version of the Children's RAP consists of three sections: (1) basic information about the child and its proxies; (2) present situation and needs of the child and its proxies; and (3) conclusions of the team conference. User satisfaction ranged from adequate to good. The Children's RAP is currently used in 53% of the Dutch pediatric rehabilitation centres. CONCLUSION: The methods used guarantee an optimal involvement of users, experts and literature. With these methods it was possible to develop an instrument which is widely accepted and implemented in clinical practice.

Child↗

PubMed1996

Clinical experience with a second-generation hospital-integrated picture archiving and communication system.

In a previous report we described a second-generation hospital-integrated picture archiving and communication system (HI-PACS) developed in-house. This HI-PACS had four unique features not found in other PAC systems. In this report, we will share some of our clinical experiences pertaining to these features during the past 12 months. We first describe the usage characteristics of two 2,000-line workstations (WSs), one in the in-patient and the second in the out-patient neuroradiology reading area. These two WSs can access neuro-images from 10 computed tomographic and magnetic resonance scanners located two medical centers through an asynchronous transfer mode network connection. The second unique feature of the system is an intensive care unit (ICU) server, which supports three WSs in the pediatric, medical surgery, and cardiac ICUs. The users' experiences and requests for refinement of the WSs are given. Another feature is physician desk-top access of PACS data. The HI-PACS provides a server connected to more than 100 Macintosh users for direct access of PACS data from their offices. The server's performance and user critiques are described. The last feature is a digital imaging and communication in medicine (DICOM) connection of the HI-PACS to a manufacturer's ultrasound PACS module. The authors then outline the interfacing process and summarize some of the difficulties encountered. Developing an in-house PACS has many advantages but also some drawbacks. Based on experience, the authors have formulated three axioms as a guide for in-house PACS development.

Computer Communication Networks↗

PubMed2001

Ecstasy is a dangerous drug.

Ecstasy, a dangerous psychoactive drug, has become a popular recreational drug on college campuses and dance halls in the United States, United Kingdom, and around the world. No reports on ecstasy have shown addictiveness, and some users of ecstasy claim they prefer infrequent use which is not the usual addictive pattern. Jaw clenching, bruxism, and some cardiac arrhythmias requiring medical attention have been associated with consumption of ecstasy and some fatalities. In large scale retrospective questionnaire studies of subjective experiences users claimed that they felt a gentle relaxation and openness to others and few adversive effects. In rats and monkeys ecstasy has caused depletion of the neurotransmitter serotonin in the brain but similar effects have not been identified for humans. Case reports have shown panic attacks, flashbacks, paranoia, and even fatalities. The Drug Enforcement Administration in 1985 placed ecstasy in Schedule I, the most restrictive drug category.

Animals↗

PubMed2006

Patient-centred care: using online personal medical records in IVF practice.

BACKGROUND: Generic patient-accessible medical records have shown promise in enhancing patient-centred care for patients with chronic diseases. We sought to design, implement and evaluate a patient-accessible medical record specifically for patients undergoing a course of assisted reproduction (IVF or ICSI). METHODS: The personal medical record (PMR) database was developed using three formative evaluation steps, and its user-experience was evaluated through a cross-sectional study. Fifty-four patient-couples receiving an IVF or ICSI treatment in our hospital were granted access to the PMR. Main outcomes concern the usage of the PMR, the perceived usefulness of its functions and user attitudes towards privacy and financial issues. RESULTS: The PMR consists of 15 major functions that can be classified into personal information, general information and communication functions. Fifty-three patient-couples accessed the website and 51 couples filled out the evaluation questionnaire. They rated most functions as useful and preferred personalized to general functions. The results also show that some functions require further development. Patients using the PMR have little concerns regarding privacy, and 76% are willing to pay for such a service in the future. CONCLUSIONS: The patients in this study frequently and intensively used the Internet-accessible PMR. This suggests that the PMR offers very useful functions from an IVF/ICSI patient's perspective.

Databases, Factual↗

PubMed2004

Accuracy and precision of manual baseline determination.

Vibrational spectra often require baseline removal before further data analysis can be performed. Manual (i.e., user) baseline determination and removal is a common technique used to perform this operation. Currently, little data exists that details the accuracy and precision that can be expected with manual baseline removal techniques. This study addresses this current lack of data. One hundred spectra of varying signal-to-noise ratio (SNR), signal-to-baseline ratio (SBR), baseline slope, and spectral congestion were constructed and baselines were subtracted by 16 volunteers who were categorized as being either experienced or inexperienced in baseline determination. In total, 285 baseline determinations were performed. The general level of accuracy and precision that can be expected for manually determined baselines from spectra of varying SNR, SBR, baseline slope, and spectral congestion is established. Furthermore, the effects of user experience on the accuracy and precision of baseline determination is estimated. The interactions between the above factors in affecting the accuracy and precision of baseline determination is highlighted. Where possible, the functional relationships between accuracy, precision, and the given spectral characteristic are detailed. The results provide users of manual baseline determination useful guidelines in establishing limits of accuracy and precision when performing manual baseline determination, as well as highlighting conditions that confound the accuracy and precision of manual baseline determination.

Algorithms↗

PubMed2004

Educational impact of in-training assessment (ITA) in postgraduate medical education: a qualitative study of an ITA programme in actual practice.

OBJECTIVES: To investigate the experiences and opinions of programme directors, clinical supervisors and trainees on an in-training assessment (ITA) programme on a broad spectrum of competence for first year training in anaesthesiology. How does the programme work in practice and what are the benefits and barriers? What are the users' experiences and thoughts about its effect on training, teaching and learning? What are their attitudes towards this concept of assessment? METHODS: Semistructured interviews were conducted with programme directors, supervisors and trainees from 3 departments. Interviews were audiotaped and transcribed. The content of the interviews was analysed in a consensus process among the authors. RESULTS: The programme was of benefit in making goals and objectives clear, in structuring training, teaching and learning, and in monitoring progress and managing problem trainees. There was a generally positive attitude towards assessment. Trainees especially appreciated the coupling of theory with practice and, in general, the programme inspired an academic dialogue. Issues of uncertainty regarding standards of performance and conflict with service declined over time and experience with the programme, and departments tended to resolve practical problems through structured planning. DISCUSSION: Three interrelated factors appeared to influence the perceived value of assessment in postgraduate education: (1) the link between patient safety and individual practice when assessment is used as a licence to practise without supervision rather than as an end-of-training examination; (2) its benefits to educators and learners as an educational process rather than as merely a method of documenting competence, and (3) the attitude and rigour of assessment practice.

Anesthesiology↗

PubMed2004

Detection of temporal delays in visual-haptic interfaces.

This paper addresses the question of how large the temporal delay between a visual and a haptic stimulus may be such that the stimuli are still perceived as being synchronous. Participants had to judge whether the moment at which a graphical object collided with a virtual wall occurred simultaneously with the moment at which a force was felt through a force feedback joystick. Participants either moved the joystick to drive the object (active touch) or held the joystick in a steady position while the object moved by itself (passive touch). Participants were found to be very sensitive to visual-haptic time delays. Sensitivity was higher for passive touch than for active touch. The minimum delay at which participants judged the stimuli as asynchronous was on average 45 ms. The delay at which the proportion of synchronous judgments reached a maximum was on average close to zero. The results indicate that the temporal accuracy of visual-haptic interfaces has to meet stringent requirements in order to optimize the overall realism that users experience. Actual or potential applications of this research include teleoperation, medical training, computer-aided-design, and scientific visualization.

Data Interpretation, Statistical↗

PubMed2001

Use of the AIDA diabetes simulation software--www.2aida.org--as an interactive educational tool for teaching student nurses.

In previous "Diabetes Information Technology & WebWatch" columns, various user experiences with an interactive educational virtual diabetes patient simulator, called AIDA, have been documented. The simulator is available free of charge from www.2aida.org on the Web. In the 5+ years since the program was first made available on the Internet, over 125,000 people have visited the AIDA Website and over 27,000 copies of the program have been downloaded, gratis. User comments that have been received about the program have highlighted some of the many and varied ways in which a range of people have been applying the diabetes simulations in their own particular situations and practices. Inevitably, up to now, a great deal of attention has focused on use of the program by individuals with diabetes and their relatives, as well as by health-care professionals such as diabetologists/endocrinologists, diabetes educators, and primary care physicians (general practitioners [GPs]). However, an important group of health-carers involved in the provision of day-to-day care for many people with diabetes are nurses. The current "Diabetes Information Technology & WebWatch" column overviews a workshop held in June 2001 in Italy to gain experience with application of the AIDA diabetes simulation approach as a teaching tool for student nurses. Feedback obtained from participants attending the workshop was generally very positive, with the student nurses reporting the simulation approach to be both of interest and of use. Further workshops involving other health-care students and professionals-in particular, medical students and qualified nurses-are planned.

Computer Simulation↗

PubMed2006

Online shopping interface components: relative importance as peripheral and central cues.

The Elaboration Likelihood Model (ELM) uses central (more thoughtful) and peripheral (less thoughtful) routes of persuasion to maximize communication effectiveness. This research implements ELM to investigate the relative importance of different aspects of the user experience in online shopping. Of all the issues surrounding online shopping, convenience, access to information, and trust were found to be the most important. These were implemented in an online conjoint shopping task. Respondents were found to use the central route of the ELM on marketing messages that involved issues of minimizing travel, information access, and assurances of system security. Users employed the peripheral ELM route when considering usability, price comparison, and personal information protection. A descriptive model of Web-based marketing components, their roles in the central and peripheral routes, and their relative importance to online consumer segments was developed.

Adult↗

PubMed2005

Optimized source selection for intracavitary low dose rate brachytherapy.

A procedure has been developed for automating optimal selection of sources from an available inventory for the low dose rate brachytherapy, as a replacement for the conventional trial-and-error approach. The method of optimized constrained ratios was applied for clinical source selection for intracavitary Cs-137 implants using Varian BRACHYVISION software as initial interface. However, this method can be easily extended to another system with isodose scaling and shaping capabilities. Our procedure provides optimal source selection results independent of the user experience and in a short amount of time. This method also generates statistics on frequently requested ideal source strengths aiding in ordering of clinically relevant sources.

Algorithms↗

PubMed2004

Factors affecting speech understanding in gated interference: cochlear implant users and normal-hearing listeners.

Previous work [Nelson, Jin, Carney, and Nelson (2003), J. Acoust. Soc. Am. 113, 961-968] suggested that cochlear implant users do not benefit from masking release when listening in modulated noise. The previous findings indicated that implant users experience little to no release from masking when identifying sentences in speech-shaped noise, regardless of the modulation frequency applied to the noise. The lack of masking release occurred for all implant subjects who were using three different devices and speech processing strategies. In the present study, possible causes of this reduced masking release in implant listeners were investigated. Normal-hearing listeners, implant users, and normal-hearing listeners presented with a four-band simulation of a cochlear implant were tested for their understanding of sentences in gated noise (1-32 Hz gate frequencies) when the duty cycle of the noise was varied from 25% to 75%. No systematic effect of noise duty cycle on implant and simulation listeners' performance was noted, indicating that the masking caused by gated noise is not only energetic masking. Masking release significantly increased when the number of spectral channels was increased from 4 to 12 for simulation listeners, suggesting that spectral resolution is important for masking release. Listeners were also tested for their understanding of gated sentences (sentences in quiet interrupted by periods of silence ranging from 1 to 32 Hz as a measure of auditory fusion, or the ability to integrate speech across temporal gaps. Implant and simulation listeners had significant difficulty understanding gated sentences at every gate frequency. When the number of spectral channels was increased for simulation listeners, their ability to understand gated sentences improved significantly. Findings suggest that implant listeners' difficulty understanding speech in modulated conditions is related to at least two (possibly related) factors: degraded spectral information and limitations in auditory fusion across temporal gaps.

Adult↗

PubMed2000

An evaluation of patient access to their electronic medical records via the World Wide Web.

This paper describes initial experience with the Web-based Patient Clinical Information System (PatCIS). The system was designed to serve as a framework for the integration of applications that help patients access their electronic medical record, add data to their record, review on-line health information, and apply their own clinical data (automatically) to guideline programs that offer health advice. The architecture supports security functions and records user activities, relieving application developers from concerns about safe information practices and the evaluation process. PatCIS is being used to study the social and cognitive impact of allowing patients to have access to their health records via the Web. To date, PatCIS has grown to include 15 clinical functions and 4 dynamic links to literature (called infobuttons). Eleven patients have been enrolled since April, 1999; five have been active users. Experience shows that the PatCIS architecture supports application integration while providing adequate security and evaluation functions. Initial caution with the patient enrollment process has limited recruitment and, consequently, usage. However, experience thus far suggests that PatCIS has good usability and utility. No adverse events, including undesirable impact on doctor-patient interactions, have been reported. There do not appear to be any technical impediments to scaling up the enrollment to continue to observe patient usage.

Computer Security↗

PubMed2006

A review of the acute subjective effects of MDMA/ecstasy.

AIM: Although several relatively recent reviews have summarized the neuropsychiatric effects associated with chronic ecstasy use, there is no published comprehensive review of studies on the acute subjective effects (ASEs) of MDMA/ecstasy. DESIGN: The present study reviewed the prevalence, intensity and duration of ASEs collected from 24 studies that provided frequency data on the prevalence of self-reported ecstasy effects and/or provided data on the intensity of ecstasy effects. FINDINGS: Although hundreds of ASEs have been reported following MDMA consumption, we identified a subset of effects reported repeatedly by meaningful proportions and large numbers of participants across multiple investigations, most of which were either emotional (e.g. anxiety, depression, closeness, fear, euphoria, calmness) or somatic (e.g. nausea/vomiting, bruxism, muscle aches/headache, sweating, numbness, body temperature changes, fatigue, dizziness, dry mouth, increased energy). Only one sexual ASE (sexual arousal/increased sensual awareness), one cognitive ASE (confused thought), one sensory-perceptual ASE (visual effects/changes in visual perception), one sleep-related ASE (sleeplessness) and one appetite-related ASE (decreased appetite) were reported across five or more investigations. Three factors-number of hours between ingestion and assessment, dose level, and gender-have been associated with the acute subjective experience of MDMA/ecstasy. CONCLUSIONS: This review provides useful information for clinicians and researchers who want to understand the desirable and undesirable ASEs that may motivate and restrain ecstasy use, for public health advocates who seek to reduce biomedical harms (e.g. fainting, dehydration, shortness of breath, bruxism) associated with recreational use of MDMA/ecstasy, and for educators who wish to design credible prevention messages that neither underestimate nor exaggerate users' experiences of this drug.

Adolescent↗

PubMedDate not supplied

Applying an evaluation framework for health information system design, development, and implementation.

BACKGROUND: Dramatic advances in health information technologies necessitate a comprehensive evaluation framework covering all phases of development, from conception to routine operational use. OBJECTIVES: The purpose of this article was to illustrate the application of an informatics evaluation framework that provides a heuristic for matching the stage of system design and the level of evaluation. METHODS: An evaluation framework is illustrated in the context of five studies in different stages of system design. RESULTS: The studies discussed in this article represent the various stages of the framework. In addition, they are examples of how evaluation research studies not only contribute to the assessment of system design but also constitute distinct contributions to knowledge. DISCUSSION: The ability to engineer advanced information systems has exceeded the understanding of how to deploy them effectively in complex settings and to adapt them to a range of user populations. A systematic, continuous evaluation increases the likelihood that the conditions for success will be understood, including how to tailor a system, how to maintain the target population's use of the system, and how to innovate continually to enhance the functionality of the system and the users' experience. Without sound evaluation methodologies throughout the stages of system development, information systems have limited potential to influence healthcare processes positively.

Humans↗

PubMed2005

New directions for critical internet health studies: representing cancer experience on the web.

Studies of health representations on the internet have been preoccupied with the assessment of their (medically-defined) accuracy and quality. This contrasts with studies of health representations in 'old' media, where critical sociological analyses are common. Medical sociologists have been concerned to establish the potential of web information in transforming professional-client relations. A case study of breast and prostate cancer web sites provides evidence of the increasing convergence of the 'new' medium of the internet and old media such as newspapers and television. Large institutions are now consolidating their presence on the web so that users experience increasingly similar messages across media platforms. Search engines and links to the web from old media sources direct people to heavily resourced, mainstream health sites where, in the case of cancer, representations of gender are strikingly similar to those found in studies of old media sources. The media convergence thesis contrasts with earlier celebrations of the internet as a new medium that would promote a diversity of perspectives on health. Using existing methods for analysing media texts and developing new methods where appropriate, sociologists and media analysts interested in health need to develop more critical perspectives on this important new medium.

Breast Neoplasms↗

PubMed2005

Automatic left atrium segmentation by cutting the blood pool at narrowings.

This paper presents a method to extract heart structures from CTA and MRA data sets, in particular the left atrium. First, the segmented blood pool is subdivided at narrowings in small components. Second, these basic components are merged automatically so that they represent the different heart structures. The resulting cutting surfaces have a relatively small diameter compared to the diameter of the neighboring heart chambers. Both steps are controlled by only one fixed parameter. The method is fast and allows interactive post-processing by the user. Experiments on various data sets show the accuracy, robustness and repeatability of this approach.

Algorithms↗

PubMed2005

Oral surgical handpiece use time parameters.

PURPOSE: To evaluate the clinical usage time parameters of handpieces used in oral surgical procedures. METHOD AND MATERIALS: One hundred randomly selected clinical oral surgery exodontia procedures were timed to record lengths of continuous segments of both handpiece use and non-usage. Providers with experience ranging from general dentists to board certified oral surgeons were timed during surgical exodontia treatment involving 1 to 4 teeth of various complexities. Usage times were compared with manufacturers' recommendations that on times should not exceed 20 seconds in any 50-second interval (20/50 rule). RESULTS: Handpiece run time increased with the number of teeth and surgical case complexity (both P < .001) but was unrelated to operator experience (P = .763), in a 3-predictor model (R2 = 0.20; P < .001). Ninety-four of the 100 cases experienced at least 1 second in violation of the 20/50 rule and 42% of all run seconds were in violation. CONCLUSION: Clinicians should be aware of recommended handpiece duty use cycles. Manufacturers' recommendations about handpiece use time cycles do not reflect actual clinical usage. Under the conditions of this study, actual surgical handpiece use time was not correlated with user experience. Less experienced providers did require longer to complete treatment, but increased treatment times were due to time spent that did not require surgical handpiece use.

Clinical Competence↗

PubMed1992

Female condom launched in UK.

The lone-awaited female condom, Femidom, is to be launched at the end of September by manufacturers Chartex. It is being welcomed by the FPA [Family Planning Association] and other family planning experts as a valuable addition to the existing range of contraceptive methods and as an alternative to the male condom in offering effective protection against sexually transmitted diseases including HIV. A lubricated, loose-fitting polyurethane sheath, Femidom is inserted into the vagina at any time before sex. An inner ring holds the condom in place beyond the pubic bone and an outer ring lies flat against the vulva. In addition to extending choice, it is under direct control of the woman. As FPA Director Doreen Massey puts it: "We have to face the fact that some women who want safer sex can't get their partners to use condoms. for the 1st time with Femidom, you can insist that if he won't use a condom, you'll use yours." In trails of self-selected couples, up to 2/3 of women and their partners found the product acceptable. a study at the Institute of Population Studies in Exeter showed that while some couples had initial misgivings about the condom's size and appearance, especially its visibility when in position, these often declined with repeated use. Researcher Dr. Nicholas Ford pointed out that if the female condom makes a woman feel unattractive, her partner's comments may well influence these feelings. Users' experience of insertion and the condom's comfort also improved with repeated use. While there are no large studies showing ranges of effectiveness, it is likely to be as effective as the male condom (about 85%-98%). In a study of 106 women at the margaret Pyke Center in London, there were 7 unplanned pregnancies: 4 were due to inconsistent use of the method and 3 were method failures. Breakages were rare. 1/3 of participants dropped out in the 1st month. Users should continue with their existing contraceptive method until they are sure that they are using Femidom efficiently, recommended the authors. In October the FPA is launching a new free consumer leaflet on male and female condoms. 1/2 million leaflets will be distributed to UK pharmacies in October and November via the Pharmacy Healthcare Scheme as part of a safer sex campaign. a launch event will include the results of a survey asking pharmacists and consumers what they think of condoms.

Behavior↗