Pustular psoriasis and hepatotoxicity associated with use of Skin Cap spray.
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Administration, Topical↗
Biomedical subjects
J K Tan
Publications and source records attributed to J K Tan.
Design of effective health decision support systems: towards automating the health administrators's decision processes.
There has been very little evidence to suggest the effective use of, and demand for, computer-based systems by health care administrators to support their increasingly complex decision-making activities. This is so, despite a considerable amount of research attention paid to examining the efficiency and power of mathematical models, and the application of increasingly sophisticated Management Science Techniques to problems encountered within the health care system over the last several years. In recent times, advancing computer technology: 1) promises to close the gap between theory and practice, 2) creates a new perspective for computerized decision support in health care organisations, and 3) points to the need for new directions in research. This paper highlights the factors that are critical to the success of interfacing between health managerial decision-makers and effective computerized decision aids.
Budgets↗
Health graphics: reconciling theory and practice in the 21st century.
This presentation attempts to break away from traditional beliefs about the promises of computer graphics, particularly regarding their application for information management within the health care industry. A key question in graphical interface research for designers and practitioners is whether human information processing, including perceptual, cognitive, and decisional effectiveness, can and will improve with the use of innovative (e.g., color graphics) versus traditional modes (e.g., monochrome tables) of representation. A careful survey of the large existing bodies of empirical literature bearing on this question suggests that too much medical information processing has proceeded through the blind creation of new forms of computer graphical interface without a preliminary thinking about the cognitive aspects of the task at hand. Several research-based guidelines are drawn to provide both the practitioners and users with insights as to how one should best approach the selection of a particular graphical interface for use in a health administrative or clinical information system setting. The presentation also suggests directions for future research in the domain of health graphics for information management and clinical decision support.
Adult↗
Exponential smoothing method for forecasting drug expenditures.
A model for forecasting a hospital pharmacy drug budget is described, and its results in 10 hospital pharmacy departments are evaluated. A model for forecasting inpatient drug expenditures was developed based on the method of exponential smoothing. Exponential smoothing predicts a value based on the forecast for the prior period, with adjustment for the error of that forecast. Recent data are weighted more heavily than older data; as data become older, weights decline exponentially. The model incorporates changes in workload in addition to drug expenditure data. The variable used for workload can vary from one hospital to another, depending on the statistics that are available. The model was designed to be more accurate than current methods, easy and quick to use, and usable with a minimal knowledge of statistics and forecasting theory. The model was tested on fiscal 1988-1992 drug budget data from 10 British Columbia hospital pharmacy departments. Four departments had insufficient data; of the remaining six, the forecasting model performed better than the hospitals' current methods in four departments. The mean absolute deviation between budgeted (by current methods) and actual drug expenditures was 8.70% (range, 6.19-15.16%). The forecasting model yielded a mean absolute deviation of 5.93% (range, 3.13-7.66%). Better forecasts resulted when pharmacy medication-order volume was used as a workload variable, as compared with hospital inpatient days. An exponential smoothing model improved the accuracy of drug-budget forecasts in four of six pharmacy departments.
British Columbia↗
Computerized databases for emergency care: what impact on patient care?
A field-based evaluation is conducted of a Clinical Computerized Information System (CCIS). Following training, the use of the CCIS database, word processing and other programs by thirteen full-time practicing emergency physicians in two urban emergency departments of a University-associated teaching hospital was studied over a one-year period. A tracking program automatically logged frequency and duration of use by the physicians, and user satisfaction was assessed by a reliable and validated questionnaire instrument. Based on utilization data and verbal reports of these physicians, CCIS database searching was not only found to be easy-to-learn but was readily accessible during emergency shifts. Individual physicians were found to perform an average of 3.5 searches per month lasting a mean search time of 8 min. Positive notes about the CCIS system included ease-of-use, accuracy of data, accessibility of system, and value of output while negative perceptions included a lack of integration with other systems, a lack of system completeness, and a high subscription cost. It was suggested that a less costly telephone link to a high-volume Centre would be desirable in actual implementation of the system.
Attitude of Health Personnel↗
Integrating health care with information technology: knitting patient information through networking.
This article discusses the importance of integrating health care with information technology to improve the efficiency, effectiveness, and innovation of health care institutions. It is argued that in addition to networking and the selection of a distributed client/server architecture that conforms to open systems protocols, the adoption of standards and the establishment of a management technology infrastructure would provide the necessary steps and mechanisms to allow for a smoother transition to greater sophistication in the development of total systems integration.
Computer Communication Networks↗
Pooled analysis of the efficacy of bacille Calmette-Guerin (BCG) immunotherapy in malignant melanoma.
BACKGROUND: The trials of bacille Calmette-Guerin (BCG) as adjuvant therapy in malignant melanoma conducted over the preceding 2 decades have presented conflicting claims of efficacy. OBJECTIVE: Determination of the role of BCG immunotherapy in malignant melanoma. METHODS: Critical analysis of randomized clinical trials of stage I and II melanoma and all reported trials of intralesional and oral BCG in stage III melanoma was conducted. A literature search used the Medline data base (1966-1992);bibliographic reviews of relevant texts and pertinent articles. RESULTS: No significant benefit of BCG as postsurgical adjuvant therapy in stage I malignant melanoma was observed. Although two of seven trials in stage II melanoma demonstrated benefit with the addition of BCG, the trial with the greatest power in this series detected no difference in outcomes. In stage III malignant melanoma, there was no significant benefit with addition of BCG to various chemotherapeutic regimens. Oral BCG monotherapy produced complete responses in 6%, partial responses in 1%, and extended survival in 7% of patients. Objective responses were observed primarily in patients with intracutaneous non-visceral metastases. Pooled analysis of 15 non-controlled trials of intralesional BCG injections revealed complete responses in 19%, partial responses in 26%, and extended survival in 13% of patients with stage III melanoma. Objective responses to intralesional BCG were more likely in patients with solely cutaneous metastases, particularly intradermal lesions. CONCLUSION: Pooled analysis of non-placebo controlled trials of intralesional BCG for stage III malignant melanoma supports a trend to enhanced survival in patients with cutaneous non-visceral metastases.
BCG Vaccine↗
Utilization care plans and effective patient data management.
This article introduces the concept of a utilization care plan (UCP) for supporting the communication of data required for effective utilization review and utilization management. Utilization review is a process of measurement that compares the performance of a ward, department, or entire facility against accepted criteria to identify resource use shortfalls. Utilization management is the deliberate action by third party payers to ensure that shortfalls in resource utilization are minimized. Critical to the success of utilization management is effective data communication; utilization review data must be accurate, complete, accessible, timely, and coordinated. Computer-based UCP systems can remind caregivers when and what services should be provided to patients and also monitor the portion of those services that should be administered during each phase of a patient's therapy. Deviations from the UCP system template constitute variances that can be documented and highlighted in a friendly automated system that ensures highly accurate and extremely timely concurrent utilization information. Some implications of using UCP systems for future research and practice are also discussed.
British Columbia↗
Graduate education in health information systems: having all your eggs in one basket.
Until recently, the technological evolution of information systems (IS) within the health care field has been relatively slow and sporadic in comparison to IS development in other industries. With the growing proliferation of powerful computers and personal workstations among health professionals, the advancement of IS technologies in the health care field has great potential. Hence, there is increasing pressure to integrate IS curricula into graduate level health administration education. This article combines earlier IS curricula from both the management and health care perspectives into an integrated framework for the development of a graduate education program in health information systems (HIS). The framework divides the HIS field into three modules: (1) HIS technologies and applications; (2) HIS theories and methodologies; and (3) HIS administration and impacts. This framework is also applied to the structuring of a master's level course for training generalists in HIS with a strong emphasis on the planning and management of hospital information systems.
British Columbia↗
Surgical waiting lists I: Definition, desired characteristics and uses.
In the first of this two-part series, the authors define waiting lists, review the waiting list situation in Canada, discuss factors affecting such lists, outline their desired characteristics and describe the analysis and use of waiting list data. The manner in which lists are compiled results in significant differences which makes the meaning of waiting lists difficult to determine. From the literature reviewed and interviews with various health service executives, the authors show that waiting lists, as compiled today, are not a valid and reliable measure of the extent of unmet demands for hospital care. In Part II, which will be published in the next issue of FORUM, the authors will present the results of an exploratory survey done to determine how waiting lists and times are presently being compiled and used in secondary and tertiary hospitals. These findings will be summarized and compared to the desired characteristics and uses of a waiting list as presented in Part I.
Canada↗
Surgical waiting lists II: Current practices and future directions using the Province of British Columbia as a test study.
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British Columbia↗
Identifying effective treatments for uremic pruritus.
The identification of effective treatments for uremic pruritus used a literature search of MEDLINE (1966 to March 1991), Index Medicus (1978 to March 1991), bibliographic reviews of textbooks, and pertinent articles. Only randomized controlled clinical trials were selected for analysis. Assessment of study quality was performed independently by two observers with specific methodologic criteria. A clinically significant therapeutic effect was defined as a statistically significant result in the proportion of patients improving and a reduction in pruritus score of at least 50%. Clinically significant outcomes were obtained for two of three whole-body ultraviolet B trials. Meta-analysis of the ultraviolet B trials retained the significant effect in analysis of proportions (pooled odds ratio 18; 95% confidence interval 4, 161). Trials of lidocaine, charcoal, and nicergoline demonstrated either statistically significant improvement in pruritus score or in proportions, but not both. Ultraviolet B phototherapy is the treatment of choice in moderate to severe uremic pruritus.
Clinical Trials as Topic↗
Going north on a north-bound trail: a model for achieving health management goals and objectives.
A basic managerial problem in decision making is to synthesise and priorise information relating to the achievement of organisational goals and objectives. This paper discusses the role of critical success factors in health services planning as a means for sorting out and specifying relevant information necessary for achieving organisational goals and managerial objectives. The proposed approach enhances existing planning procedures for health care organisations. Within a conceptual framework of the health care system, managerial insights are provided for the realisation of organisational goals via measurable managerial objectives using critical success factors as pointers to success. More importantly, this paper introduces a planning model which incorporates the CSF concept for developing new health care programmes and for evaluating or restructuring existing programmes.
Health Facility Planning↗
Attitudes of female patients regarding oral contraceptives for treatment of acne.
BACKGROUND: Two hormonal agents with contraceptive properties are currently indicated in Canada for treatment of acne. OBJECTIVE: The purpose of this study was to determine the attitudes and concerns of female patients regarding the use of hormonal agents and oral contraceptives in treatment of acne. METHODS: A self-completed questionnaire was administered to all female acne patients of a community-based dermatologist over a 10-week period between June and August 1999. Statistical analysis was performed by chi-square testing at the 5% significance level. RESULTS: Eighty-six percent recognized that oral contraceptives ("birth control pills") were also used as a treatment for acne and 60% were willing to use this form of treatment. The most common concern regarding the use of oral contraceptives were side effects (80%). Younger patients were seven times more likely to be concerned about potential disapproval or misunderstanding on the part of others regarding the use of these medications (p approximately 0.01). CONCLUSION: Female acne patients recognize that oral contraceptives are useful in treatment of acne. Although side effects of these medications are of general concern, social disapproval is of particular concern to younger patients.
Acne Vulgaris↗
The determination of relevant goals and criteria used to select an automated patient care information system: a Delphi approach.
OBJECTIVES: To determine the relevant weighted goals and criteria for use in the selection of an automated patient care information system (PCIS) using a modified Delphi technique to achieve consensus. DESIGN: A three-phase, six-round modified Delphi process was implemented by a ten-member PCIS selection task force. The first phase consisted of an exploratory round. It was followed by the second phase, of two rounds, to determine the selection goals and finally the third phase, of three rounds, to finalize the selection criteria. RESULTS: Consensus on the goals and criteria for selecting a PCIS was measured during the Delphi process by reviewing the mean and standard deviation of the previous round's responses. After the study was completed, the results were analyzed using a limits-of-agreement indicator that showed strong agreement of each individual's responses between each of the goal determination rounds. Further analysis for variability in the group's response showed a significant movement to consensus after the first goal-determination iteration, with consensus reached on all goals by the end of the second iteration. CONCLUSION: The results indicated that the relevant weighted goals and criteria used to make the final decision for an automated PCIS were developed as a result of strong agreement among members of the PCIS selection task force. It is therefore recognized that the use of the Delphi process was beneficial in achieving consensus among clinical and nonclinical members in a relatively short time while avoiding a decision based on political biases and the "groupthink" of traditional committee meetings. The results suggest that improvements could be made in lessening the number of rounds by having information available through side conversations, by having other statistical indicators besides the mean and standard deviation available between rounds, and by having a content expert address questions between rounds.
British Columbia↗
The normal electro-oculogram among Filipinos.
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Adolescent↗