Biomedical subjects

T Timpka

Publications and source records attributed to T Timpka.

At least 19 recordsLinked to original sources

PubMed1999

A prototype computer network service for occupational therapists.

Due to recent reforms, the demands on the people working in community-oriented health care service are increasing. The individual providers need professional knowledge and skills to perform their tasks quickly and safely. The individuals are also confronted with new tasks and situations of which they lack experience. At the same time, the resources for education and development are decreasing. The aim of this paper is to describe the implementation of a prototype computer network service to support occupational therapists in their daily work. A customized Quality Function Deployment (QFD) model, including participatory design elements, was used for: (a) identification of the occupational therapists' needs; and (b) for the transformation of these needs to prioritized design attributes. The main purpose of the prototype was to improve the visualization of the design attributes that were found to support the occupational therapists. An additional purpose was to be able to evaluate the design attributes and further improve them. The specific aim of this article is to describe the initial prototype with respect both to the tools and the information content.

Humans↗

PubMed1999

The epidemiology of back pain in vocational age groups.

OBJECTIVES: To investigate the prevalence of back pain in a general population aged between 20 and 59 years. POPULATION: A representative sample of 2000 individuals from Ostergotland County, Sweden (population 400,000). STUDY DESIGN: Cross-sectional study using a questionnaire including the pain drawing. RESULTS: The observed point prevalence was 28% (95% confidence interval 26-31%). The adjusted prevalence taking into account the non-responders was 23% (21-25%). Lumbar pain with radiation was reported by 40%, while 4% had only cervical pain with radiation. Twelve per cent were on sick-leave due to back pain. Activity of daily life was affected mainly in the group of men aged 40-59 and only in household tasks. The back problems did not affect social activity. CONCLUSIONS: The prevalence of back problems in the vocational ages was found to be 23%. Only small parts of a pain population are on sick-leave or have changed working tasks because of back problems. The distribution of pain in most cases is combined with radiation to extremities and not isolated to a single region. The combination of different localisations shows the pain problem to be more than just a "low back" problem.

Adult↗

PubMed1999

Community-based injury prevention: effects on health care utilization.

BACKGROUND: Worldwide, an estimated 78 million people are disabled each year because of unintentional injuries and about 3 million die. The WHO Safe Community model is a framework for community-based injury prevention programmes. The aim of this study is to evaluate the outcome on health care utilization of a Safe Community programme. METHODS: The incidence of injuries treated at health care facilities in an intervention municipality (pop. 41,000) was compared to the injury incidence in a control municipality (pop. 26,000). The incidence was recorded immediately before and one year after programme implementation from registrations made during all first-contact health care visits and from examination of hospital discharge registers. RESULTS: The incidence of health care treated injuries in the intervention area had decreased by 13% (95% CI: 9-16%) from 119 (95% CI: 115-122) per 1000 population-years to 104 (95% CI: 101-107). In the control area, the corresponding injury incidences were 104 (95% CI: 100-108) and 106 (95% CI: 102-109). The hospital-treated injuries in the intervention area decreased by 15% (95% CI: 7-24%) from 19 (95% CI: 17-20) per 1000 population-years to 16 (95% CI: 15-17), while in the control area, the incidences remained at 13 (95% CI: 11-14) per 1000 population-years. Utilization of acute care in the intervention area for reasons other than injuries increased by 8% (95% CI: 6-10%), while in the control area, the number of visits did not show significant change. CONCLUSION: This first controlled evaluation showed that an injury prevention programme based on local action groups can significantly reduce injuries requiring health care in a community. Local prevention can provide a complement to national level campaigns.

Adolescent↗

PubMed1999

The medical software quality deployment method.

UNLABELLED: The objective of this study was to develop a Quality Function Deployment (QFD) model for design of information systems in health-care environments. Consecutive blocked-subject case studies were conducted, based on action research methods. RESULTS: Starting with a QFD model for software development, a model for information system design, the Medical Software Quality Deployment (MSQD) model, was developed. The MSQD model was divided into the pre-study phase, in which the customer categories and their power to influence the design are determined; the data collection phase, in which the voice of customers (VoC) is identified by observations and interviews and quantified by Critical. Incident questionnaires; the need specification phase, where the VoC is specified into ranked customer needs; and the design phase where the customer needs are transformed stepwise to technical requirements and design attributes. QFD showed to be useful for integrating the values of different customer categories in software development for health-care settings. In the later design phases, other quality methods should be used for software implementation and testing.

Consumer Behavior↗

PubMed1999

Professional ethics for system developers in health care.

Medical informaticians are multidisciplinary professionals responsible for developing complex technical systems. The aim of this study was to investigate how a code of ethics can help medical informaticians in avoiding design failures. An exploratory case study was performed to identify factors related to failure during system development. The literature on professional ethics was reviewed to derive a preliminary code of ethics. The case study showed that collaboration across individual and professional values is required to avoid failure during system development in health care. Having either the employer or the health care providers in focus for moral judgments may be misleading and cause confusion. The preliminary code emphasizes socialization, education and cooperation rather than enforced compliance. As a code is a distillation of experiences, its major benefit to medical informaticians should be its clarification of the profession's position in society.

Ethics, Professional↗

PubMed1998

Development of systems for support of collaboration in health care: the design arenas.

To explore the design of computer-supported collaborative work in health care, a case study is described addressing the social contexts and conditions influencing the development process. The data set covers 13 consecutive meetings held in a systems design group over a 2-year period, in total approximately 24 h of video recordings. Subjectivist methods are used for the data analyses. The results suggest that the development of computer-supported collaborative work in health care is situated at three social arenas: the societal arena, the organizational arena and the workplace arena. These are visited by the design group in patterns which correspond to the micro-, meso- and macro-level social structures involved in the design. The study displays that longitudinal analyses of design meeting dialogues provide the opportunity of improving the understanding of external influences on design processes in health care.

Computer Communication Networks↗

PubMed1998

The WHO safe community program for injury prevention: evaluation of the impact on injury severity.

Despite the fact that injuries consume a considerable amount of health care resources world-wide, 3.5 million people die from unintentional injuries each year. To handle this central public health problem, WHO has introduced the Safe Community accreditation for injury prevention programs. This study was to investigate the impact from a Safe Community program with regard to injury severity. Data were collected in Motala municipality (population = 41,000), Ostergötland county, Sweden, during one year before and one year after program intervention, from two sources: registration of trivial (AIS 1) and non-trivial (AIS 2-6) unintentional injuries from all acute care episodes in the area and recollection of hospital bed days from discharge registers. The incidence of non-trivial injuries treated in health care was found to have decreased by 41% (95% confidence interval, 37-45%), while the trivial injuries increased by 16% (9-22%). The larger decrease of non-trivial injuries was observed in all ages and injury event environments. The total number of bed days at emergency hospitals due to injuries decreased by 39% (37-41%) from 1983-84 to 1989, while the hospital bed utilization for other reasons decreased by 9% (8-9%). The study showed the implementation of a WHO Safe Community program led to the harm from unintentional injuries within the community being considerably more reduced than that of the injury incidence. In future assessments of injury prevention programs, classification of injury severity should be included to increase the validity of inter-program comparisons.

Abbreviated Injury Scale↗

PubMed1998

Pain drawing evaluation--the problem with the clinically biased surgeon. Intra- and interobserver agreement in 50 cases related to clinical bias.

To assess whether the clinical knowledge of the treating surgeon had any effect on the reliability of the pain-drawing evaluation, drawings from 50 low-back pain patients were evaluated by the treating surgeon and by three colleagues who had no clinical knowledge of the patient. The evaluation was repeated after 10 days. The treating surgeons were also blinded to clinical data. The kappa value in the evaluation when the surgeon had clinical knowledge of the patient was lower (0.29 (95% Cl 0.13-0.45)) than the kappa value in the evaluations made without clinical knowledge (0.60 (Cl 0.45-0.75)). The differences observed in interobserver reliability between open and blind evaluations suggest that clinical knowledge of a patient influences the evaluation of the pain drawings.

Adult↗

PubMed1998

Knowledge discovery and case based reasoning in health promotion: development of a help-desk for prevention of occupational injuries.

This paper presents the concepts, ideas and techniques behind Case Based Reasoning (CBR) in relation to knowledge extraction techniques for health promotion. The ultimate goal is to develop a help-desk service for advice about preventive measures to be taken concerning concrete occupational injury hazards. CBR has been suggested to be a complimentary method to knowledge extraction in order to take direct advantages of large databases for building decision support systems. In this work a database on work injuries is being used to develop a CBR application using a CBR shell-called Recall.

Accidents, Occupational↗

PubMed1998

Use of project ontologies and terminology servers to support software engineering.

Complex medical software imposes new requirements on the methods and tools used for maintenance. Appropriate maintenance tools can increase software reliability and quality by providing means to trace dependencies among software artifacts for reducing unexpected impacts in software caused by software changes. We have used the GRAIL concept-representation language for medical terminologies to build a project ontology that models relationships among software artifacts. Our approach involves modeling of the terminology used in software projects, which enables us to describe, classify and relate individual software artifacts. A networked repository accessible to the entire software development staff stores the conceptual model, source code and associated documents. We present an architecture for a maintenance tool, and show how developers can use GRAIL to build a project ontology.

Databases as Topic↗

PubMed1998

The economic implications of users willingness to increase knowledge capital in health informatics.

OBJECTIVE: To develop an economic model of health care professionals demand for knowledge capital in health informatics. DESIGN: Case study with application of the Contingent Valuation Method to develop a small-scale model. SETTING: Specialized clinic at a university Hospital in Sweden. RESULTS: The model displays the economic rationale behind an individual's choice to spend leisure time for obtaining knowledge in health informatics. This decision reduces the total leisure time, but does not increase salary. Instead, it may increase the personal well being by higher satisfaction gained from using information systems and by being recognized as a computer expert. CONCLUSIONS: Individuals have preferences over all uses of time and for activities they can choose to engage in Support of health care staff's investment in health informatics knowledge capital may benefit both the individuals and indirectly the health care organization.

Attitude of Health Personnel↗

PubMed1998

Heuristic walkthrough evaluation of a prototype computer network service for occupational therapists.

AIM: To identify utility and design criteria for a computer network service for occupational therapists. DESIGN: Heuristic walkthrough evaluation. The evaluators explored a prototype and then commented upon the design in plenary sessions. SUBJECTS: One group of information system design experts and one of occupational therapists. RESULTS: The central utility criteria were the possibility to organize dynamic work groups for development of the occupational therapy profession and access to databases on assistive technologies. The main system design criteria identified were navigation, structure, tools, and content. CONCLUSION: A computer network service can support the development of the therapy professions. Generic issues exist which need to be considered in the detailed design. The heuristic walkthrough method is useful for identifying these.

Computer Communication Networks↗

PubMed1998

Risk perception during information system development in non-profit health care organizations.

The perception of risk exposure among design team members during the early phases of information system development projects can provide valuable strategic information for clinical organizations. To develop a typology of perceived risks during information system development projects in health care, interviews were performed with key team members from a specialist clinic, primary health care, and an informatics research group, during the requirements specification. Phenomenological data analysis and secondary integration of the results in available theories were performed. System objectives, the user requirements definition procedure, the communication pattern between design team members and project management were found to be perceived as the main risk areas. In the secondary analysis, the technical factors, identified as preventing a maximization of the use of the resources, were lack of informatics knowledge among economic decision makers and differences between customers and suppliers regarding their views on the nature of system design. During the implementation of a given strategy, decision makers may consider the requests of their own sponsors in the first place and maximize the use of the project resources in the second place. Informatics knowledge plays a key role in risk perception during the development of an information system in health care. Political considerations by team members are important to take into regard, since these may influence technical and economic decisions.

Humans↗

PubMed1997

Long-term economic effects of team-based clinical case management of patients with chronic minor disease and long-term absence from working life.

OBJECTIVES: To examine the socio-economic effects of team-based clinical case management of patients with chronic minor disease bound for early retirement. DESIGN: Marginal analysis of programme costs and benefits to society compared with no-programme baseline of costs occurring in society due to productivity loss. Prospective patient data collection on admission, discharge, and at one year and five years after discharge to determine programme effectiveness. SETTING: Out-patient clinic at the department of social medicine in tertiary care hospital. SUBJECTS: 239 patients with minor disease and long-term vocational absence consecutively admitted to the study. At the one-year evaluation, 17 patients had been readmitted to the team, 7 could not be found, 6 declined the interview and 2 were deceased. At the five-year evaluation of 49 patients who were active after one year, one was deceased and 10 were unable to be found. MAIN OUTCOME MEASURES: Vocational activity. Programme costs. Benefits to society measured by decrease in indirect costs. RESULTS: The one-year vocational rehabilitation rate from the program was 20.5% and the five-year rehabilitation rate was 11.3%. The total discounted cost for case management of the 239 patients was 7.3 MSEK (600,000 Pounds). The decrease in the indirect costs to society from the 28 patients found active after five years was 35.1 MSEK (2,500,000 Pounds). The net present value of the programme at the 1991 price level was 27.5 MSEK (2,365,000 Pounds). CONCLUSIONS: Tertiary care level team-based clinical case management for vocational rehabilitation of patients with chronic minor disease has a positive cost-benefit ratio. A cross-boundary awareness at a health policy level is needed of the societal costs involved for this group of patients who fall between the traditional services in health care and social work.

Absenteeism↗

PubMed1997

Study of situation-dependent clinical cognition: a meta-analysis and preliminary method.

An integrated method was constructed for the study of in situ clinical reasoning. A meta-analysis of existing theories and an exploratory case study were performed. Twelve physicians at the department of otorhinolaryngology, and three physicians and three biomedical technologists at the clinical microbiological laboratory of an 800-bed university hospital were involved in the evaluation of the method. The meta-analysis identified situations where practitioners face assignments for which they follow no routine strategy as suitable starting points for the development of the method, in which organizational processes are presented as workflow graphs. Using the critical incident technique, problem situations in the processes are identified, and stimulated recall interviews are employed to construct a model of the situation-dependent logic used in decision-making. The case study showed that the first levels of the method could easily be used by physicians without training in organizational development or cognitive psychology. It is concluded that the method can be a means for case construction in problem-oriented learning programs that have an empirical background. It can also be used in the development of clinical organization, where training is combined with the establishment of critical paths and computer support.

Algorithms↗

PubMed1996

Development of community nursing: analysis of the central services and practice dilemmas.

As examples of nurse practitioners in primary care, Swedish district nurses have been shown, in several studies, to respond well to the general pressure to achieve higher productivity in health care. Yet they have less frequently been involved in studies of the detailed content of the service they provide. To maintain total service quality, change should not be brought about only for the sake of efficacy. This study is divided into an analysis of the basic service provided in district nursing by identifying a typical interaction with a patient; and an analysis of the daily dilemmas district nurses experience, their consequences, and possible measures for change. For the consultation study, data were collected from 40 videorecordings of office-hour consultations by a rural district nurse. Regarding the dilemma situations, a critical incident questionnaire was returned by 153 district nurses in a Swedish country. The analyses showed that the district nurse practises in an area between self-care on the one hand, and the intersection of the different specialties in health care, on the other. Both the consultation study and the study of dilemmas in practice showed that the district nurse has to approach the health care organisation from a viewpoint close to that of the patient, which implies that she can, and has to, maintain an overview of the patient's total interaction with social institutions. This focal localisation of the shared care and co-ordination aspects constitutes a critical target for change and development efforts. The conclusions are that, first, the role of the district nurse/nurse practitioner as co-ordinator and advocate in patient-centred care could be considered in central health services policies and planning. Second, the content of the district nurses' daily work could be taken into account in the implementation of quality programs. These measures together can lead to an integration between today's theoretical nursing models and the dynamically changing structures of health care organisations.

Adult↗

PubMed1996

Ten years of experiences from a participatory community-based injury prevention program in Motala, Sweden.

Exploratory studies in the Scandinavian countries have suggested that the national cost of unintentional injuries is equal to 4% of the Gross National Product (GNP). One way for Swedish society to handle this situation has been through community-based injury prevention programs. This study used action research methods to supplement the understanding of the community development for injury prevention. The aim of this paper is to present the participative model used in one of the first of these programs, the Motala Injury Prevention Program, and lessons learned from the first 10 years of its operation. The program 'succeeded' in 1993, when Motala Municipality formed a regular Safety Board chaired by the Municipal Commissioner. These are five main messages from the initial phases of the program: a community-based injury prevention program has to be regarded as a long-term project; preferably over more than a 10 year period, economic calculations are important in the community analysis phase of the program, inter-linkage between community organizations is essential in the design phase, the hand-over from the initial program developers to practitioners is critical in the implementation phase, it is important to maintain a high-quality data collection routine even after the conclusion of the community analysis phase of the program. These observations have a potential to be valid at least for Northern Europe, which, by comparison with other parts of the world is a relatively homogenous area with regard to external causes of injuries. Regarding other communities, there are known differences in injury rates and community organization.

Adolescent↗

PubMed1996

Division of labour in clinical microbiology. Co-operation and fragmentation.

The aim of this study was to describe clinical microbiological practices in a hospital setting. A grounded theory was developed from qualitative data in two steps: initial participant observation to describe the clinical work-flow, and a main case study based in depth interviews and analyses of work practices using a video-based stimulated recall technique. Six physicians, 2 senior medical laboratory technologists and one head nurse were interviewed in depth based on their organizational positions. Stimulated recall interviews were conducted with 11 nurses, 6 secretaries, 6 medical laboratory technologists, and 3 physicians. An informal clinical microbiological 'workgroup' was found to co-operate around two physical objects: the microbiological sample and the laboratory request form. Work organization was divided into planning, based on science and legislations, and performance based on tradition and local supervision. None of the practitioners had a total overview of an analysis cycle, all being occupied with a discrete part of planning, practical work and information management. The conclusion of the study is that fragmentation in the division of labour may be a critical hindrance to development in clinical microbiology. If a common strategy is not shared between specialties and professions, even minor changes in routines by individual practitioners may influence patient outcome.

Cooperative Behavior↗