Biomedical subjects

T Timpka

Publications and source records attributed to T Timpka.

87 records · Page 5Linked to original sources

PubMed1990

The GP's dilemmas: a study of knowledge need and use during health care consultations.

For use in system development, a method based on both qualitative and quantitative data was employed to study the difficulties--the dilemmas--a general practitioner (GP) faces during daily consultations. Video recordings were used for stimulated recall of the consultation. From 46 consultations, 262 dilemmas were identified by the 12 GPs involved. Medical dilemmas were encountered during three out of four consultations. Dilemmas in the communication with the patient occurred during two consultations out of three, while dilemmas in the organizational environment and dilemmas challenging the GP's personal competence occurred during one consultation out of three, respectively. A phenomenological analysis of the comments showed that few dilemmas were described as problems during "hypothetico-deductive reasoning". In many cases the GP found it difficult to understand the situation as a whole. Based on these qualitative data, a model of the GP's management of ill-structured complex dilemmas is discussed and proposed, to be taken into account in the development of decision support systems for outpatient practice.

Adult↗

PubMed1989

Introducing hypertext in primary health care: a study on the feasibility of decision support for practitioners.

A study on the feasibility of the introduction of hypertext systems for communication of medical knowledge in primary care is described. Shortliffe's constraints on areas for application of decision support are evaluated (i.e., theoretical barriers, observable and recognized needs among users, sources of usable knowledge, available system development method). Considering the barriers derived from the knowledge types and forms used by practitioners, hypertext was found suitable as support at 'breakdowns' in practice routines, to generate 'alarms', as well as for continued medical education. A survey of the a priori acceptance of decision support systems by general practitioners showed that 84% would use the computer support if it was available today and that full-text databases, such as hypertext, were given highest priority for introduction. Local specialist physicians were identified as knowledge sources for therapy advice. Implementation of prototype systems envisioned use of hypertext in primary care as the introduction of a communication medium for co-operative health care decision making. A model for the introduction into the work environment is described.

Attitude to Computers↗

PubMed1989

The semantics of diagnosis and management of genitourinary infections: a cross-specialty study.

To investigate agreement between physicians about diagnosis and management concepts of genitourinary infection, data from 63 symptomatic women was collected and distributed to a panel consisting of three general practitioners, three urologists and three nephrologists. Using double-blind methods, the panel was asked individually to give a preliminary diagnosis and a management recommendation for each case. Pairwise comparison of the evaluations showed 66% agreement for diagnosis and 79% agreement for prescription of antibiotics. Adjusting for chance agreement, the kappa index was 0.43 for prescription of antibiotics, 0.31 for diagnosis of cystitis, 0.20 for vulvovaginitis, 0.21 for pyelonephritis and 0.09 for urethritis. The specialist groups ordered significantly more laboratory investigations, resulting in a 75-95% more expensive work-up compared with general practitioners. The findings imply a need for more distinct use of the concept of 'urethritis' and are consistent with previously demonstrated differences in resource use between general practitioners and specialist physicians.

Anti-Bacterial Agents↗

PubMed1989

Information needs and information seeking behaviour in primary health care.

A questionnaire survey of 186 general practitioners in Sweden showed that 67% saw the overall supply of medical information as less satisfactory or unsatisfactory, and that 80% experienced major hindrances in seeking relevant information. The most frequent need for information concerned general medicine, with respect to both diagnosis and choice of therapy. Of situations which required additional information, only every second was completely resolved. These results imply a need for a reorganization of the supply of information to general practitioners. As they cannot depend on conventional medical libraries for day-to-day information, personal libraries should be improved and updated regularly, and be readily to hand. Computer technology should be considered for communication between health care providers, and as support for differential diagnosis in general medicine.

Consumer Behavior↗

PubMed1987

Knowledge-based decision support for general practitioners: an integrated design.

Most decision-support systems (DSSs) in medicine have been developed in hospital environments, for use in hospitals. Only a few are designed for use by general practitioners (GPs) in primary care. The work reported in this paper aims to (a) design DSSs for GPs in primary care, taking into consideration that primary care is the first level in a health care organization, where the reasons for the patients attendance are seen in a social context; and (b) integrate three approaches-Hypertext, Knowledge-Based Systems and Online Library-since any one of these will not suffice for the varying needs of GPs.

Academic Medical Centers↗

PubMedDate not supplied

Healthcare professional's demand for knowledge in informatics.

OBJECTIVE: To develop an economic model of health care professional 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 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.

Health Personnel↗

PubMedDate not supplied

Following the thread of Ariadne to the health of women.

The health of women has risen to a priority position in medical research. Comparative studies of female morbidity are called for as an intermediary stage for generation of hypotheses and design of deeper studies of determinants, such as social, ecological, and individual factors. In previous studies, we have noted differences in female hospitalization between Heraklion in Greece and Linköping in Sweden. They were related to age and to urban versus rural dwelling, and fit projections for a more archaic and a more technocratic society, respectively. This paper aims at showing how the study of women's health may proceed from relevant hospitalization observations to the next level, of exploring already available indicators of self-perceived health in elderly females.

Age Factors↗

PubMedDate not supplied

Survival with pain: an eight-year follow-up of war-wounded refugees.

The aim of this study was to investigate the nature of chronic pain in male war-wounded refugees and to examine the relationship between chronic pain and psychiatric symptoms. A culturally heterogeneous group of 44 war-wounded refugees were investigated during hospitalization, shortly after arrival, and followed up after two years. This study is an additional follow-up after eight years. The data collection methods used were structured interviews and physical examination. The measures of outcome were: Visual Analogue Scale (VAS) grading of pain; clinical categorization of pain into nociceptive or neurogenic; Hopkins Symptom Check List (HSCL-25); Post Traumatic Symptom Scale (PTSS-10). Chronic pain was found in 32 (73%) out of 44 subjects. The pain was purely nociceptive and neurogenic in 53% and 25%, respectively. The frequency of psychiatric symptoms was significantly related to the mean intensity of pain. War-wounded refugees display psychiatric symptoms and chronic pain in a complex pattern. Further research is needed as a basis for pain rehabilitation programmes suitable for this group.

Adult↗

PubMedDate not supplied

War-wounded refugees: the types of injury and influence of disability on well-being and social integration.

The aim of this study is to describe the war injuries and investigate the influence of physical disability on well-being and social integration in a group of war-wounded refugees after two years in Sweden. A culturally heterogenous sample of 54 war-wounded refugees was investigated during hospitalization shortly after arrival, and after two years. Quantitative data were covered by physical examinations, interviews and questionnaires. In addition, qualitative data were collected within semi-structured interviews on both occasions. The major types of war injuries were: fractures (22%), traumatic amputations (17%), spinal cord injuries (17%), nerve injuries (11%), combinations of fractures and nerve injuries (9%), bilateral eye injuries (9%), brain injuries (7%), other injuries (7%). Regarding the type of injuries and medical complications, the group studied was representative of small unit operations of war with low access to early medical care. The degree of physical disability was not a salient factor for well-being and social integration after two years in Sweden. The losses and desires to be repatriated were apparent from the qualitative findings, as exemplified by three case reports. The findings of this study are in accordance with previous research on refugees and war-injured ex-combatants, but further multidisciplinary research is needed. The results also imply that resettlement countries should pay continuous attention to the broad needs of their war-wounded refugees.

Humans↗

PubMedDate not supplied

Acceptability of computerized self-report of alcohol habits: a patient perspective.

The acceptability of computerized assessment of alcohol habits was explored in 57 consecutive out-patients over a 6-month period. Altogether, 46 men and 11 women agreed to complete a paper and pencil questionnaire exploring their opinion about computerized assessment. The study focused on the patients' acceptance of computerized testing and also on whether some sub-groups had reservations. The participants indicated that they had no general anxiety towards computers and did not mind being assessed by their use. Nearly half of the men were not convinced of the usefulness of computers as a means of asking about alcohol habits. The same level of confidence was recorded with regard to whether doctors would make better assessments using computers. Around one-quarter of both men and women were worried that computers might cause doctors to spend less time with the patients and that staff might lose the personal contact with patients. Because of the small sample size, we conclude tentatively that a computerized lifestyle test appears to be an acceptable method both to men and women with different educational backgrounds. However, two important issues need to be further addressed, namely concerns about confidentiality and loss of personal contact.

Adult↗

PubMedDate not supplied

Participatory design of information systems in health care.

AIM: To study the objectives, processes, and ideologies expressed during participatory design of information systems (PDIS) in health care. DESIGN: Longitudinal documentation of project meetings by video recording. Grounded theory development in three steps. SETTING: Systems development project in primary care. RESULTS: The developing system was discussed mainly from a clinical and practical, as opposed to a technical, viewpoint. The design decisions were related to societal-level participants and institutions. This external influence on design decisions was mediated by design voices in discussions, each having its own scope. CONCLUSIONS: The social environment has to be considered when applying PDIS in health care. Instructions for nondesigners can be used to introduce them to the design objectives, processes, and ideologies on which PDIS is based and to support them when relating clinical and practical design questions to the existing social constraints and norms.

Group Processes↗

PubMedDate not supplied

Improvement of decisions regarding hemodialysis patients by urea kinetic modeling.

The potentials for improving decisions about adequacy of dialysis (AD) and daily protein intake (DPI) by urea kinetic modeling (UKM) were examined. Four nephrologists evaluated AD, DPI, and metabolic stability in 62 patients. UKM was done three times; but the results were not revealed. Clinicians' decisions were then compared with UKM measures of effective dialysis (Kt/V) and protein catabolic rate (pcr). Detection of inadequately treated patients by the clinicians was poor (28%, Kt/V less than 1.0; and 40%, Kt/V less than 0.9). Specificities of the clinicians' decisions were 0.96 and 0.92, respectively. Combining pcr and consensus decisions, 59 patients could be assigned a probable DPI. Using this as "gold standard," the average clinician detected 77% of 13 low DPIs. Single or triple pcr determinations alone detected 77% or 62%, respectively. Specificities were 0.91, 0.85, and 1.0. Simulated decision making suggested that combining pcr with clinical evaluation in a logical way would lead to detection of most patients with low DPI. Qualitative data from individual patient cases causing controversies are presented and discussed. It is concluded the UKM should be used routinely to assess the adequacy of dialysis and daily protein intake.

Adult↗

PubMedDate not supplied

Interobserver variations in assessment of antral disease from direct sinoscopic observations compared to video recordings.

We tested the reliability of visual clinical sinoscopic observations by using video recordings. An edited video tape was made from the video-recorded bilateral antral sinoscopies of nine patients included in a prospective case series of inflammatory maxillary sinus disease in critically ill patients. An expert panel of four consultant ENT surgeons made individual appraisals of the video using a structured form. They had only been informed in general about the study, but had no further case knowledge in order to avoid all biases. Concordance and interobserver variabilities in the expert panel were compared in pairs. The assessments of the expert panel were compared with the observations of the performer, who was biased through individual case knowledge. Nine patients, either nasotracheally intubated or tracheotomized, had ventilator treatment for more than 7 days. One ENT surgeon performed all sinoscopies and made the direct observations. Satisfactory agreement was found on mucosal alterations. The concordance of recognizing bacterial infection was almost perfect. However, the assessment of redness from a video recording displayed only chance agreement. The differences between kappa statistic values within the expert panel group compared to the comparisons of performer versus expert panel were not significant. The case knowledge of the sinoscopist did not alter the assessments markedly and thus seemed only to have minor influence. Video recording as a method for second opinion was shown to be a useful technique, but will have to be further developed.

Adult↗

PubMedDate not supplied

A method for study of dilemmas during health care consultations.

No scientific methods have been developed for study of the difficulties or dilemmas which physicians and nurses experience during day-to-day consultations. Such methods have relevance for designers of computer-based decision support systems, medical educators, and administrators. This paper describes the theoretical background and details of a method where a video-recording is reviewed for stimulated recall of the perceived difficulties that occur during doctor-patient consultations. A phenomenological analysis is performed of the video-review comments. The stated dilemmas are categorized, using Habermas's epistemological theory, into those involving medical knowledge, social knowledge and personal competence. In a study of 46 primary care consultations, 262 dilemmas were identified from 400 comments. The influence of the research arrangements on the practice setting, as perceived by physicians and patients, were small.

Data Collection↗

PubMedDate not supplied

Quality functions for requirements engineering in system development methods.

Based on a grounded theory framework, this paper analyses the quality characteristics for methods to be used for requirements engineering in the development of medical decision support systems (MDSS). The results from a Quality Function Deployment (QFD) used to rank functions connected to user value and a focus group study were presented to a validation focus group. The focus group studies take advantage of a group process to collect data for further analyses. The results describe factors considered by the participants as important in the development of methods for requirements engineering in health care. Based on the findings, the content which, according to the user a MDSS method should support is established.

Decision Making, Computer-Assisted↗