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Biomedical subjects

P Jennett

Publications and source records attributed to P Jennett.

At least 19 recordsLinked to original sources
PubMed2005

Delivery of rural and remote health care via a broadband Internet Protocol network - views of potential users.

We asked the views of potential users of a proposed Canadian broadband Internet Protocol (IP) network for health, the Alberta SuperNet. The three user groups were drawn from the public, provider and private sectors. In all, 35 health-sector participants were selected (17 government, nine health-care organizations, five providers/practitioners and four private sector). The questionnaire was Web-based, semistructured and self-administered. It consisted of four major areas: value, readiness, effect on usual care and limitations. A total of 28 (80%) individuals responded to the questionnaire: 21 (81%) were from the public sector (three provincial, nine regional and nine organizational), three (60%) were from the provider sector and four (100%) were from the private sector. Overall, the items related to health services and health human resources were considered to be the most valuable to rural communities. Respondents identified the expansion of telehealth services as the most important, except those from the private sector, who ranked this a close second. The health system's move to the use of electronic health records was ranked second in importance by all respondents. The private-sector respondents viewed all user groups to be generally less ready (mean score 2.5 on a seven-point scale from 1 = not ready to 7 = ready), while the public-sector respondents were the most optimistic (mean score 4.0). Specific socioeconomic impact data were limited. The top-ranked disadvantage of the 10 suggested was that 'Changes in health-service delivery practices and/or processes will be required'.

Alberta↗
PubMed2003

The quality of a simulation examination using a high-fidelity child manikin.

PURPOSE: Developing quality examinations that measure physicians' clinical performance in simulations is difficult. The goal of this study was to develop a quality simulation examination using a high-fidelity child manikin in evaluating paediatric residents' competence about managing critical cases in a simulated emergency room. Quality was determined by evidence of the reliability, validity and feasibility of the examination. In addition, the participants' responses regarding its realism, effectiveness and value are presented. METHOD: Scenario scripts and rating instruments were carefully developed in this study. Experts were used to validate the case scenarios and provide evidence of construct validity. Eighteen paediatric residents, 'working' as pairs, participated in a manikin-based simulation pre-test, a training session and a post-test. Three independent raters rated the participants' performance on task-specific technical skills, medications used and behaviours displayed. At the end of the simulation, the participants completed an evaluation questionnaire. RESULTS: The manikin-based simulation examination was found to be a realistic, valid and reliable tool. Validity (i.e. face, content and construct) of the test instrument was evident. The level of inter-rater concordance of participants' clinical performance was good to excellent. The item analysis showed good to excellent internal consistency on all the performance scores except the post-test technical score. CONCLUSIONS: With a carefully designed rating instrument and simulation operation, the manikin-based simulation examination was shown to be reliable and valid. However, a further refinement of the test instrument will be required for higher stake examinations.

Adult↗
PubMed2001

Recommendations of the Canadian Consensus Conference on Dementia--dissemination, implementation, and evaluation of impact.

BACKGROUND: Subsequent to the development of consensus statements on a clinical topic, it is vital to establish a plan for dissemination, implementation and evaluation of impact. Consensus statements can be used for both guiding continuing medical education (CME) and producing clinical practice guidelines (CPGs). Insufficient attention to dissemination can lead to a failure to change physician behaviour and improve patient outcomes. METHODS: A plan to disseminate the conclusions of the Canadian Consensus Conference on Dementia (CCCD) was developed. This plan was based on a literature review of CME and CPGs. A Medline search was performed on the dissemination and evaluation of the 1989 Canadian Consensus Conference on the Assessment of Dementia (CCCAD) and other published guides for physicians on dementia care. CCCD dissemination that has occurred to date (June, 2000) was reviewed in this paper. RESULTS: Lectures and unsolicited printed material are weak forms of CME. Small-group interactive CME that provides practice opportunities appears to be the most effective way to change physician behaviour. The ability of CPGs to change physician behaviour is uncertain. It appears that inadequate attention has been placed on CPG dissemination and implementation. The CCCAD had a modest impact on clinical practice in Canada. While dissemination of the conclusions of the CCCD has taken place, evaluation of the impact of the CCCD has yet to be done. Local initiatives utilizing the conclusions of the CCCD are on-going. CONCLUSIONS: Further work is needed on how to optimize the impact of consensus statements and CPGs. While dissemination of the CCCD has occurred, it is currently unknown whether it has led to any change in physician practices.

Canada↗
PubMed2001

Use of telehealth technology to extend child protection team services.

OBJECTIVE: In response to increased referrals to Florida's Child Protection Teams and concern regarding statewide availability of medical expertise in the area of child abuse and neglect, Children's Medical Services of the Florida Department of Health established a telemedicine project to facilitate immediate expert medical evaluations of alleged child abuse or neglect. This article describes a baseline examination of the project, including the technique of concept mapping, to examine how larger systematic factors influence the adaptation of telemedicine technology in child abuse examination settings. METHODS: This study included interviews of key staff plus the incorporation of concept mapping, which takes qualitative data (individual statements and opinions) and quantifies them (sorts and ranks them by order of group importance). RESULTS: Findings from interviews revealed that the frequency of use of telehealth services varies across the state as a result of several factors, including space limitations and staff training. Patients, however, seem to be comfortable with the use of the new technology. The concept mapping exercise displayed a progression of issues that are perceived to have an impact on the use of this technology. CONCLUSIONS: Technology use is affected by unforeseen variables, such as physical space limitations and examination room availability. Family concerns about patient privacy issues were rare and were resolved quickly by the health care practitioner. Although using this equipment is not difficult, the search for user-friendliness should be continued. Staff engagement early in the process likely will result in a greater likelihood of use of the technology.telehealth, telemedicine, child protection, child abuse and neglect, concept mapping.

Child↗
PubMed2000

An industry, clinical, and academic telehealth partnership venture: progress, goals achieved, and lessons learned.

The goal of this project was to develop and test a multi-application telehealth workstation with an interface seamless to the end-users. This project required collaboration among the private sector, a clinical regional referral setting, a clinical tertiary receiving center, and a university academic unit. The project applied the usability testing methodology to design and test the workstation: (1) the developmental phase focused on planning, prototype workstation development, and end-user trials in the private sector research and development environment, and (2) the operational testing phase moved the workstation into the clinical setting. The latter included training of end-users and addressing policy and ethical issues. In addition, the partners documented the goals achieved and lessons learned. The project resulted in the refinement of the workstation for clinical applications. The unique, diverse, and at times complementary goals and lessons learned by each partner are noted. Collaboration around a shared goal was a key element in achieving the refined workstation. Collaborators reported that the lessons learned will aid them as they pursue telehealth activities.

Alberta↗
PubMed2000

Telelearning in a partnership between a university faculty and a regional health authority: benefits, challenges and strategies.

The University of Calgary's Faculty of Medicine and the Calgary Regional Health Authority understand that telehealth is an evolving field requiring both academic enquiry and operational readiness. Both parties are committed to quality educational programmes--the Faculty through its commitment to excellence and the Authority with its charge to maintain and enhance such programmes. There are shared applications, multi-learner user groups, shared strategies to overcome distances and shared infrastructure--technologies, communication pathways and resources. Having embarked on a joint telelearning venture, we have learned a number of lessons. Central to progress has been an appreciation and respect for unique mandates, a spirit of trust and flexibility, an agreement on a set of principles, ongoing communication between and participation from the users and, at times, redirection. Questions being answered include the following. How well is this collaborative model working? How functional is it at this time of health reform and restructuring? Can one meet complementary telelearning goals within a faculty-health authority relationship? These all have implications for future success.

Canada↗
PubMed1999

Assessment of physician performance in Alberta: the physician achievement review.

The College of Physicians and Surgeons of Alberta, in collaboration with the Universities of Calgary and Alberta, has developed a program to routinely assess the performance of physicians, intended primarily for quality improvement in medical practice. The Physician Achievement Review (PAR) provides a multidimensional view of performance through structured feedback to physicians. The program will also provide a new mechanism for identifying physicians for whom more detailed assessment of practice performance or medical competence may be needed. Questionnaires were created to assess an array of performance attributes, and then appropriate assessors were designated--the physician himself or herself (self-evaluation), patients, medical peers, consultants and referring physicians, and non-physician coworkers. A pilot study with 308 physician volunteers was used to evaluate the psychometric and statistical properties of the questionnaires and to develop operating policies. The pilot surveys showed good statistical validity and technical reliability of the PAR questionnaires. For only 28 (9.1%) of the physicians were the PAR results more than one standard deviation from the peer group means for 3 or more of the 5 major domains of assessment (self, patients, peers, consultants and coworkers). In post-survey feedback, two-thirds of the physicians indicated that they were considering or had implemented changes to their medical practice on the basis of their PAR data. The estimated operating cost of the PAR program is approximately $200 per physician. In February 1999, on the basis of the operating experience and the results of the pilot survey, the College of Physicians and Surgeons of Alberta implemented this innovative program, in which all Alberta physicians will be required to participate every 5 years.

Alberta↗
PubMed1999

The effect of information technology on the physician workforce and health care in isolated communities: the Canadian picture.

The ratio of physicians to population in Canada peaked in the mid-1990s and is now falling. The decrease in the number of family physicians has had a disproportionate effect on rural and remote communities, and surveys have indicated that the availability of physicians and services is likely to deteriorate in rural and remote communities. Telemedicine is increasingly evident in every Canadian province and territory, and it could assist in more effective use of workforce resources by linking appropriate experts at central sites to patients and practitioners at remote sites. Positive effects on recruitment and retention of health providers and morale of the local workforce can be expected. In spite of national interest, evidence for the effect of telemedicine on staff distribution, roles and recruitment, use of health resources, health management and system integration is very limited. Telephone interviews were therefore conducted to collect information from 12 telehealth projects in Canada, one from each province or territory. The responses confirmed observations in the literature that telemedicine has positive outcomes for the workforce.

Canada↗
PubMed1998

Development and validation of an evaluation tool for multimedia resources in health education.

The last decade saw a rapid increase in the use of multimedia in health education. Easy availability, accessibility, low cost of technological resources and the expanding body of research on the role of multimedia in student learning, among others, have all contributed to this increase in usage. Since one of the roles of educators is to assess and select learning resources based on curriculum goals and student needs, the development of standardized methods for multimedia evaluation becomes vital. To the learner, it is important for reviews of the quality of the resource to be readily available. An evaluation too was developed based on the recognition of this need. The validity of the tool was tested using experts in technology and education. Reliability was determined using faculty and students who reviewed the same software, using the tool. In addition, graduate students reviewed two versions of a nursing program, of varying quality. The results indicate that the tool is reliable and valid. It is envisaged that this tool can be utilized by health educators for evaluating multimedia resources and setting up a much needed clearinghouse for health education resources.

CD-ROM↗
PubMed1996

Telemedicine and security. Confidentiality, integrity, and availability: a Canadian perspective.

The health care system is undergoing major reform, characterized by organized delivery systems (regionalization, decentralization, devolution, etc); shifts in care delivery sites; changing health provider roles; increasing consumer responsibilities; and accountability. Rapid advances in information technology and telecommunications have led to a new type of information infrastructure which can play a major role in this reform. Compatible health information systems are now being integrated and connected across institutional, regional, and sectorial boundaries. In the near future, these information systems will readily be accessed and shared by health providers, researchers, policy makers, health consumers, and the public. SECURITY is a critical characteristic of any health information system. This paper will address three fields associated with SECURITY: confidentiality, integrity, and availability. These will be defined and examined as they relate to specific aspects of Telemedicine, such as electronic integrated records and clinical databases; electronic transfer of documents; as well as data storage and disposal. The guiding principles, standards, and safeguards being considered and put in place to ensure that telemedicine information intrastructures can protect and benefit all stakeholders' rights and needs in both primary and secondary uses of information will be reviewed. Implemented, proposed, and tested institutional, System, and Network solutions will be discussed; for example, encryption-decryption methods; data transfer standards; individual and terminal access and entry I.D. and password levels; smart card access and PIN number control; data loss prevention strategies; interference alerts; information access keys; algorithm safeguards; and active marketing to users of standards and principles. Issues such as policy, implementation, and ownership will be addressed.

Canada↗
PubMed1996

Increased use of cardiovascular medications in seniors prescribed non-ASA non-steroidal anti-inflammatory drugs.

The objective of this study was to determine the relationship between the prescribing of non-ASA non-steroidal anti-inflammatory drugs (NANSAID) and the prescribing of select cardiovascular (CV) medications. We performed a retrospective, cross-sectional analysis of the prescribed use of these medications between December 1, 1990 and June 30, 1991 by Albertans 65 years of age and older utilizing data from the publically-funded drug benefit plan. Variables examined were: the number of individuals prescribed NANSAID and CV medications; mean daily dose for these medications; calculated relative dose; the proportion of NANSAID users prescribed CV medications compared to non-users; and the relative proportions of users of specific NANSAID prescribed CV medication. We found that 33.4% and 19.6% of Albertan seniors were prescribed CV medications and NANSAID, respectively. NANSAID users were twice as likely to be prescribed CV medications as compared to non-users. Intermediate/high dose NANSAID users were more likely to be prescribed a CV medication as compared to low-dose users. The risk of being prescribed a CV medication was highest for indomethacin and users of multiple NANSAID, while ibuprofen users had the lowest risk. We conclude that NANSAID users are more likely to be also prescribed CV medications. Subjects who consume a lower dose of NANSAID are less likely to be prescribed CV medications. For different NANSAID, there is a spectrum of risk.

Age Factors↗
PubMed1994

Prescription of nonsteroidal anti-inflammatory drugs for elderly people in Alberta.

OBJECTIVE: To examine the extent prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) are used by elderly people in Alberta as well as the degree of concurrent use of multiple NSAIDs, of peptic ulcer medications and of certain medications known to have clinically significant adverse interactions with NSAIDs. DESIGN: Retrospective analysis of the Alberta Blue Cross database. SETTING: Alberta. PATIENTS: All people 65 years of age and older using the subsidized drug benefit plan for whom prescription claims were submitted for reimbursement between Jan. 1 and June 30, 1991. OUTCOME MEASURES: Number of people who received one or more prescriptions for NSAIDs, rates of prescribing peptic ulcer medications and drugs with the potential for clinically significant interactions with NSAIDs among NSAID users and non-NSAID users, and rate of prescribing more than one NSAID concurrently. RESULTS: Of the Albertan population 65 years of age and over 61,601 (26.7%) received at least one prescription for an NSAID during the study period. In decreasing order, the five most commonly prescribed NSAIDs were acetylsalicylic acid, diclofenac, naproxen, indomethacin and ibuprofen. The total cost of NSAID therapy was $5,415,974. Of the people prescribed an NSAID 25.8% were also prescribed a peptic ulcer medication, as compared with 10.5% of the non-NSAID users. There was a significant relation between the increasing number of NSAID prescriptions and the likelihood of receiving a peptic ulcer medication. Those who received a prescription for an NSAID were more likely than non-NSAID users to have been prescribed coumarin anticoagulants, diuretics, angiotensin-converting-enzyme inhibitors, beta-blockers, oral corticosteroids, methotrexate and lithium, all of which are known to have possible adverse interactions with NSAIDs. A total of 2,631 people had two or more prescriptions for NSAIDs filled on the same day. CONCLUSIONS: NSAIDs are prescribed frequently for elderly people and are associated with an increased likelihood of concurrent prescription of peptic ulcer medication and medications that could have adverse drug interactions with NSAIDs. Additional study is required to evaluate the appropriateness of NSAID use in elderly patients, to determine the degree of actual patient consumption of these medications, to document the true prevalence of clinically significant drug interactions and to formulate educational strategies to reach physicians with this information.

Aged↗
PubMed1994

Putting prevention into practice.

In primary medical care settings, disease prevention services are delivered at lower rates than recommended. Furthermore, practitioners tend to overestimate the rate at which they perform them. There are essentially two steps in delivering evidence-based preventive services: (1) knowing what the evidence is for performing various detection and intervention manoeuvres, and (2) integrating the preventive services into daily practice. The first is a scientific process and is carried out in Canada by the Canadian Task Force on the Periodic Health Examination. However, after a decade of experience with evidence-based guidelines, we now know that guidelines are not enough. Integrating clinical prevention into busy practices is a political and logistical process. This truth is best captured by the quip, "An ounce of prevention requires a pound of office system change". A number of studies have demonstrated that continuing medical education (CME) courses and workshops for physicians are not enough to ensure that clinical preventive services are incorporated into practice. According to Lomas, the traditional CME educational approaches need to be complemented by strategies from such paradigms as the social influence model, the diffusion of innovation model and the adult learning model. Battista, in "From Science to Practice," points out the complexity of the communication process required for the diffusion of innovation into practice. Walsh's Systems Model of Clinical Preventive care best captures the interacting factors that mediate between practitioners' intentions and their actions when it comes to delivering clinical prevention services. This paper reports on a practical example of helping family practitioners develop a "sustaining office system in prevention" that minimizes barriers, focuses energy and integrates clinical prevention into office routines. The key components are (i) a practice coordinator for prevention, (ii) clear clinical prevention-related job descriptions for all persons who deal with patients, (iii) an information management system that reinforces prevention, and (iv) a practice feedback and problem solving strategy.

Aged↗
PubMed1988

Family physician registration at locally produced short courses.

Physicians who do not take advantage of short courses that are offered within their community may miss the opportunity to learn about new services and consultants as well as to validate new information or practices with trusted colleagues. The registration patterns at short courses of all 505 family physicians in Calgary were assessed to determine whether the sociodemographic characteristics of attendees differed from those of nonattendees and whether the sociodemographic data were predictive of attendance or nonattendance. Four variables were predictive of attendance or nonattendance: certification status with the College of Family Physicians of Canada (CFPC), year of graduation, sex and hospital affiliation. Physicians who had attended four or more courses were more likely to be graduates of Canadian or US schools, to have graduated after 1969, and to be women, certificants of the CFPC and affiliated with a hospital. Universities, hospitals and professional associations planning continuing education must determine if the needs of nonattending physicians are being met through other means or if new strategies are required to ensure that these physicians have opportunities for upgrading their knowledge. Practitioners who frequently attend short courses can help planners ensure that programming is relevant.

Alberta↗
PubMed1988

Career and practice profiles of Alberta medical graduates (1973-85) practising in Alberta.

This collaborative study examined the career choices and practice locations of the 940 (58%) of the Alberta medical students graduating between 1973 and 1985 who remained in Alberta. Of the 686 practising graduates slightly less than two-thirds were in family/general practice; the remainder were in a specialty. More women (76%) than men (60%) had chosen family/general medicine. The women graduates spent about 10 hours less a week on patient care than their male colleagues. Personal and professional factors were cited most often as determinants of practice location. Approximately 20% of the practising graduates chose to locate in small towns or rural areas. Accessibility to consultants and opportunities for continuing medical education were reported as vital prerequisites for more physicians to move to smaller Alberta centres. These findings provide a starting point for studies designed to determine how Alberta medical school graduates are contributing to patient care within the province.

Alberta↗
PubMed1988

Raising questions in clinical practice.

Answers are required by family physicians to numerous questions during a day of patient care. This study examined the number of questions that arose during one day to which family physicians did not have an answer, the library resources to which the family physicians had access and used, and the relationship between the number of questions that arose in practice and library resources or use. Volunteer family physicians (N = 87) reported a mean of 6.8 questions. When accessing libraries, physicians relied primarily on their office and home libraries. Personal libraries had fewer than ten textbooks published since 1980 and subscriptions to fewer than five journals. T-test analysis indicated that the physician with the most questions practiced in the medical school community, was a graduate of a Canadian or United States medical school, and attended a course on problem raising and solving. The number of questions did not differ by the holdings in the physician's library, the age or sex profile of the patients, the number of patients seen or the frequency with which the physician used his personal library. Medical educators and librarians should provide educational opportunities to assist family physicians develop their personal libraries, their problem solving skills and their use of modern technology to access the literature.

Alberta↗
PubMed1988

Medical school M.D. graduates' activities in research and teaching (Alberta medical schools--1973-85).

The paucity of clinicians entering research and teaching careers has been noted. This study examines the proportion of M.D. graduates from Alberta medical schools (with different selection and educational philosophies) who have chosen such careers, and discusses when the graduates' major research interests developed and the significance of the findings to future manpower requirements.

Alberta↗