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Biomedical subjects

T Timpka

Publications and source records attributed to T Timpka.

At least 37 records · Page 2Linked to original sources
PubMed2001

Economic motives to use a participatory design approach in the development of public-health information systems.

Within public health, there is a tradition of co-operation between researchers and communities in planning and implementation of health promotion programs. As a consequence, public-health organizations are characterized by having complex multidisciplinary structure and dynamic organizational goals. In this paper, we discuss the economic impacts from the use of Participatory Design for development of public-health information systems. Creation of systems that have both utility and usability is suggested to be highlighted as the central goal. The identified pre-requisites for a positive impact are that the new system should be of high quality, appropriate to the nature of the health promotion tasks, and to how activities are coordinated and integrated both between and within the stakeholder groups involved. We argue further that a method that minimizes the information asymmetry in the development process is necessary for avoiding market failures 1. The conclusion is that participatory design will diminish transaction costs, will help to avoid sunk costs, and will contribute to rich efficient use of human and economic resources in public-health organizations.

Community Participation↗
PubMed2001

Adaptation of the critical incident technique to requirements engineering in public health.

The introduction of modern information systems in public health provides new possibilities for improvements in public health services and hence also of population's health. However, development of information systems that truly supports public health practices requires that technical, cognitive, and social issues be taken into consideration. In requirements engineering for public health, a notable problem is that of capturing all aspects of the future user's voices, i.e., the viewpoints of different public health practitioners. Failing to capture these voices will result in inefficient or even useless systems. The aim of this paper is to report a requirements-engineering instrument to describe problems in the daily work of public health professionals. The issues of concern thus captured can be used as the basis for formulating the requirements of information systems for public health professionals.

Information Systems↗
PubMed2001

Towards second-generation smart card-based authentication in health information systems: the secure server model.

Conventional smart card-based authentication systems used in health care alleviate some of the security issues in user and system authentication. Existing models still do not cover all security aspects. To enable new protective measures to be developed, an extended model of the authentication process is presented. This model includes a new entity referred to as secure server. Assuming a secure server, a method where the smart card is aware of the status of the terminal integrity verification becomes feasible. The card can then act upon this knowledge and restrict the exposure of sensitive information to the terminal as required in order to minimize the risks. The secure server model can be used to illuminate the weaknesses of current approaches and the need for extensions which alleviate the resulting risks.

Computer Security↗
PubMed2001

Immunization against Haemophilus influenzae type b in Sweden--a study of the introduction process.

AIMS: To study the introduction of Haemophilus influenzae type b (Hib) vaccination in Sweden, and to identify factors promoting and inhibiting the process. METHODS: The introduction of general childhood vaccination against Hib in Sweden in 1992-93 was studied using the Cultural Historical Activity Theory as a theoretical framework. RESULTS: Five activity systems were found to be involved in the introduction process, the systems of vaccine production, government administration, news distribution, science, and disease prevention. The critical factors for introduction of the programme were found to be the vaccine product, conception of the disease, government economy and public decision-making. CONCLUSIONS: The results show that a broad range of non-biomedical aspects must be considered when a public health intervention such as a general vaccination programme is introduced.

Child↗
PubMed2000

The patient and the primary care team: a small-scale critical theory.

The patient and the primary care team: a small-scale critical theory For increasing the understanding of team-based delivery of primary care, ratings of care satisfaction and stimulated-recall interviews were used to compose a small-scale critical theory. Three teams and 24 patients at a community health care centre participated in the study. It was found that the multiprofessional team was vulnerable to discrepancies between the health service policy and the available care resources. If pre-paid patients arrive with too high expectations and demands on the service, a significant part of the team's attention is used for economizing with care procedures. When health and economics are entangled for the team, the patients are not invited to share decisions about their health. The patients' concerns are instead turned to the social arena, which is separated by language and context from the health analysis. Simultaneously, when the teams are led to solve the health problems without involving the patients in the process, the team members convert these to their own personal distress when they fail. The conclusion is that the discrepancy between care policy and factual resources is an important cause of imbalance in patient-primary care team interaction. If service strategy and team organization and resources are not continuously adjusted to each other, the effects will continue to obstruct communication during consultations.

Adult↗
PubMed2000

Clinical findings in a population with back pain. Relation to one-year outcome and long-term sick leave.

OBJECTIVE: To investigate whether physical examination findings can be used in predicting recovery from back pain and new episodes of sick leave. DESIGN: One-year prospective study of a single cohort. SETTINGS: Semi-rural Swedish county. POPULATION: A cross-section of a general population with back pain (207 women, 176 men) between 20 and 59 years of age. MAIN OUTCOME MEASURES: Cumulative incidence of sick leave due to back pain, cumulative incidence of sick leave due to back pain > 30 days, incidence of recovery from back pain. RESULTS: For recovery from pain, the absence of tenderness in the trapezius muscle (OR 0.33; CI 0.1-0.5) was predictive. New sick leave was predicted by tenderness in the trapezius muscle (OR 2.67; CI 1.5-4.9), and had a tendency to be associated with a flattened lumbar lordosis and a restricted cervical range of motion. For long-term sick leave, the same findings and also observation of scoliosis (OR 3.44; CI 1.1-10.5) were predictive. CONCLUSION: There are subgroups with back pain predisposed to development of more persistent symptoms and a higher risk for sick-listing.

Adult↗
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↗
PubMed1999

Information technology and knowledge exchange in health-care organizations.

Despite the increasing global interest in information technology among health care institutions, little has been discussed about its importance for the effectiveness of knowledge management. In this study, economic theories are used to analyze and describe a theoretical framework for the use of information technology in the exchange of knowledge. The analyses show that health care institutions would benefit from developing global problem-solving collaboration, which allows practitioners to exchange knowledge unrestricted by time and geographical barriers. The use of information technology for vertical integration of health-care institutions would reduce knowledge transaction costs, i.e. decrease costs for negotiating and creating communication channels, and facilitating the determination of what, when, and how to produce knowledge. A global network would allow organizations to increase existing knowledge, and thus total productivity, while also supporting an environment where the generation of new ideas is unrestricted. Using all the intellectual potential of market actors and thereby releasing economic resources can reduce today's global budget conflicts in the public sector, i.e. the necessity to choose between health care services and, for instance, schools and support for the elderly. In conclusion, global collaboration and coordination would reduce the transaction costs inherent in knowledge administration and allow a more effective total use of scarce health-care resources.

Health Care Sector↗
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↗