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Biomedical subjects

J Lyman

Publications and source records attributed to J Lyman.

At least 19 recordsLinked to original sources
PubMed2001

Investigating physician order entry in the field: lessons learned in a multi-center study.

The progress of studies by this team of researchers concerning computerized physician order entry (POE), beginning with a mail survey and moving to qualitative multi-center studies, is reviewed, with emphases on lessons learned and future directions. While mail surveys were appropriate to answer initial research questions about diffusion of POE in the U.S., multiple qualitative methods became the methods of choice for answering more complex questions. Results of the latter include articulation of multiple perspectives on both positive and negative aspects of POE and a description of what may be important for successful implementation of POE in the future. The present economic environment of hospitals may be inhibiting widespread diffusion of POE, not only because of the direct cost, but also indirectly by affecting relations with practitioners. Analysis of successful past implementations can provide guidance when the time is right.

Attitude to Computers↗
PubMed2001

A diffusion of innovations model of physician order entry.

OBJECTIVE: To interpret the results of a cross-site study of physician order entry (POE) in hospitals using a diffusion of innovations theory framework. METHODS: Qualitative study using observation, focus groups, and interviews. Data were analyzed by an interdisciplinary team of researchers using a grounded approach to identify themes. Themes were then interpreted using classical Diffusion of Innovations (DOI) theory as described by Rogers [1]. RESULTS: Four high level themes were identified: organizational issues; clinical and professional issues; technology implementation issues; and issues related to the organization of information and knowledge. Further analysis using the DOI framework indicated that POE is an especially complex information technology innovation when one considers communication, time, and social system issues in addition to attributes of the innovation itself. CONCLUSION: Implementation strategies for POE should be designed to account for its complex nature. The ideal would be a system that is both customizable and integrated with other parts of the information system, is implemented with maximum involvement of users and high levels of support, and is surrounded by an atmosphere of trust and collaboration.

Diffusion of Innovation↗
PubMed2000

Multiple perspectives on physician order entry.

OBJECTIVE: Describe the complex interplay of perspectives of physicians, administrators, and information technology staff regarding computerized physician order entry (POE) in hospitals. METHODS: Linstone's Multiple Perspectives Model provided a framework for organizing the results of a qualitative study done at four sites. Data from observation, focus groups, and formal and informal interviews were analyzed by four researchers using a grounded approach. RESULTS: It is not a simple matter of physicians hating POE and others loving it. The issues involved are both complex and emotional. All groups see both positive and negative aspects of POE. CONCLUSION: The Multiple Perspectives Model was useful for organizing a description to aid in understanding all points of view. It is imperative that those implementing POE understand all views and plan implementation strategies accordingly.

Attitude of Health Personnel↗
PubMed1993

Consequences to the patient in the event of hydraulic unit failure.

An anomalous hot spot, which occurs when the motion of the Leksell Gamma Unit is halted, was investigated. A series of measurements indicated that the source of this hot spot is the focusing property of the primary collimator. It was determined that this effect is unlikely to result in serious consequences to the patient, even in the event of failure of the hydraulic unit.

Equipment Failure↗
PubMed1991

Tolerance of normal tissue to therapeutic irradiation.

The importance of knowledge on tolerance of normal tissue organs to irradiation by radiation oncologists cannot be overemphasized. Unfortunately, current knowledge is less than adequate. With the increasing use of 3-D treatment planning and dose delivery, this issue, particularly volumetric information, will become even more critical. As a part of the NCI contract N01 CM-47316, a task force, chaired by the primary author, was formed and an extensive literature search was carried out to address this issue. In this issue. In this manuscript we present the updated information on tolerance of normal tissues of concern in the protocols of this contract, based on available data, with a special emphasis on partial volume effects. Due to a lack of precise and comprehensive data base, opinions and experience of the clinicians from four universities involved in the contract have also been contributory. Obviously, this is not and cannot be a comprehensive work, which is beyond the scope of this contract.

Bone and Bones↗
PubMed1987

Stereotactic heavy-particle irradiation of intracranial arteriovenous malformations.

Stereotactic irradiation appears to be effective in causing partial or complete thrombosis of AVM that are not surgically resectable. Use of heavy particles generated in a cyclotron allows better spatial definition and dose distribution than do other methods, allowing larger AVM to be treated. From these preliminary results, it is evident that heavy-particle irradiation therapy, like proton beam therapy, does not offer protection from recurrent hemorrhage for at least 12 months, nor is it devoid of major complications; it does offer a noninvasive mode of therapy for AVM that are difficult to treat surgically, however.

Adolescent↗
PubMed1984

Phasic relations in 90 degree abduction-adduction of the arm: the ARIMA representation.

Myoelectric signals (MES's) from the medial deltoid, posterior deltoid and medial trapezius were analyzed during 90 degree abduction-adduction cycles of arm movement. Two healthy males were utilized as subjects. The MES's records were divided into sub-sections of 50 ms of duration, and each segment was described by a suitable model. The models were based on autoregressive integrated moving average (ARIMA) processes. Several distinct phases were discerned within a given movement cycle, each phase being associated with a distinct type of ARIMA process. Phasic relations among the three muscles were then revealed. A simple test was suggested to detect the onset of muscle activity in real-time situations.

Arm↗
PubMed1983

Control of muscle contractile force through indirect high-frequency stimulation.

With a view to possible application in an orthotic device, study was made of the attenuation of background, indirectly induced muscle tetanus produced by superimposing high-frequency electrical stimulation of the muscle nerve. The effects of varying duration, current and frequency of pulses of the stimulus were outlined, and it was concluded that optimal application might be obtained using a stimulus frequency of 500 Hz, a pulse duration of 50 musec, and varying the frequency to gradate the effect.

Acoustics↗
PubMed1983

Fatigue considerations of muscle contractile force during high-frequency stimulation.

In a model for control of muscle force, wherein an induced background tetanus is attenuated by concurrent indirect stimulation at frequencies in the 0.6- to 10-kHz range, evaluation was made for effects on muscle fatigue of differing rates of the tetanic and high-frequency stimuli. Relatively little fatigue, and yet nearly the complete range of attenuation, were favored by lower frequencies of both these stimuli, e.g., tetanic stimulation at 50 Hz and a blocking frequency of 600 Hz.

Animals↗
PubMed1982

Sociological aspects of attenders and non-attenders of antenatal classes.

One hundred and eighty-six women delivering in a one-month period were questioned about their attendance at antenatal education classes and various sociological characteristics. Forty-three women had never attended antenatal classes: young women, unmarried women, Maori or Pacific Island women and women of low socio-economic status or educational achievement were disproportionately represented amongst the non-attenders. Non-attenders of antenatal classes also lacked knowledge about the classes and had more transport and child care problems when compared with attenders. The present antenatal classes are not being attended by those who would probably benefit most from education for parenthood.

Adult↗
PubMed1979

Retrocorneal pigment proliferation after cataract extraction.

Retrocorneal pigment proliferation after cateract extraction is not rare. Downgrowths proliferate from fragments of iris pigment or peripheral iris in the corneal wound edges and occur slowly. Vision is affected if the central cornea is involved. Preventive measures include minimizing iris trauma and irrigating pigment fragments from the cornea and incision during surgery. In the study presented, patches of dislodged iris pigment epithelium were observed in 22 eyes. Lace-like downgrowths occurred in 18 eyes of 14 patients.

Adult↗