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PubMedDate not supplied

Barriers to effective pediatric asthma care.

Although progress has been made in understanding the pathophysiology of asthma and identifying key features of quality asthma care, the prevalence of childhood asthma remains high. Barriers to effective asthma care that currently exist include the persistence of environmental risk factors, disparities in care that stem from poverty and cultural differences, and inconsistencies in the quality of asthma care provided by clinicians. Pediatric nurse practitioners at Yale New Haven Children's Hospital have actively implemented the recommended guidelines for asthma care and addressed causes for some of the disparities in asthma health care. Two major initiatives are described: the Asthma Care Coordination Project at Yale New Haven Hospital Pediatric Primary Care Center, and the establishment of an Asthma Outreach Program. Recommended resources and Web sites for the practitioner are also provided.

Anti-Asthmatic Agents↗
PubMed2004

Proteomics-based sequence analysis of plant gene expression--the chloroplast transcription apparatus.

The chloroplast transcription apparatus has turned out to be more complex than anticipated, with core polypeptides surrounded by multiple accessory proteins of diverse, and in part unexpected, functions. At least two different RNA-binding proteins and several redox-responsive proteins are components of the major chloroplast RNA polymerase termed PEP-A. One of the key-regulatory factors has been identified as a Ser/Thr-specific protein kinase that is sensitive to SH group modification by glutathione and by this means is able to modulate transcription. The cloned plastid transcription kinase from mustard (Sinapis alba L.) has been assigned as a member of the (mostly nucleo-cytosolic) CK2 family and hence has been termed cpCK2. Despite its apparent role in mustard chloroplast transcription, until recently no data have been available for other plant species. Using the web database resources, we find evidence for an evolutionarily conserved role of this redox-sensitive plastid transcription factor.

Amino Acid Sequence↗
PubMed2005

Legal and ethico-legal issues in e-healthcare research projects in the UK.

This report first gives an overview of e-healthcare research activity in the UK. It then summarises available information concerning legal hurdles and issues faced by these projects, provides an overview of work being carried out to investigate these hurdles, and considers some of the proposals put forward to overcome them. It is an initial scoping review (using both literary and web-based resources)-rather than a systematic or analytical review-of e-health which addresses specific strands relating to legal and ethico-legal issues and identifies activity in these areas. It is hoped that this preliminary scoping exercise will stimulate further research and analysis.

Ethics, Research↗
PubMed2004

Human exposure assessment resources on the World Wide Web.

Human exposure assessment is frequently noted as a weak link and bottleneck in the risk assessment process. Fortunately, the World Wide Web and Internet are providing access to numerous valuable sources of human exposure assessment-related information, along with opportunities for information exchange. Internet mailing lists are available as potential online help for exposure assessment questions, e.g. RISKANAL has several hundred members from numerous countries. Various Web sites provide opportunities for training, e.g. Web sites offering general human exposure assessment training include two from the US Environmental Protection Agency (EPA) and four from the US National Library of Medicine. Numerous other Web sites offer access to a wide range of exposure assessment information. For example, the (US) Alliance for Chemical Awareness Web site addresses direct and indirect human exposures, occupational exposures and ecological exposure assessments. The US EPA's Exposure Factors Program Web site provides a focal point for current information and data on exposure factors relevant to the United States. In addition, the International Society of Exposure Analysis Web site provides information about how this society seeks to foster and advance the science of exposure analysis. A major opportunity exists for risk assessors and others to broaden the level of exposure assessment information available via Web sites. Broadening the Web's exposure information could include human exposure factors-related information about country- or region-specific ranges in body weights, drinking water consumption, etc. along with residential factors-related information on air changeovers per hour in various types of residences. Further, country- or region-specific ranges on how various tasks are performed by various types of consumers could be collected and provided. Noteworthy are that efforts are underway in Europe to develop a multi-country collection of exposure factors and the European Commission is in the early stages of planning and developing a Web-accessible information system (EIS-ChemRisks) to serve as a single gateway to all major European initiatives on human exposure to chemicals contained and released from cleaning products, textiles, toys, etc.

Databases, Factual↗
PubMed2002

Evidence-based medicine: applications in dietetic practice.

Evidence-based medicine has been defined as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." Evidence-based practice requires the ability to apply knowledge of medical informatics (eg, efficiently searching the medical literature) and clinical epidemiology (eg, being able to critically appraise the literature) to the treatment of individual patients. Being able to apply the principles of evidence-based medicine in the dietetic practice adds to the credibility and value of dietetics professionals, is consistent with the dietetic code of ethics, and is empowering. This article provides an introduction to the history, philosophy, and methods of evidence-based medicine as applied to the dietetic practice. This article focuses on a 5-step process to finding the best evidence to answer clinical questions: (a) formulate the question, (b) search for answers, (c) appraise the evidence, (d) apply the results, and (e) assess the outcome. We describe the 4S methodology-a systematic approach to efficiently finding the best evidence to answer clinical questions involving the use of systems (comprehensive, evidence-based resources), synopses (compilations of structured abstracts of high-quality studies), syntheses (systematic reviews), and studies (original research articles). Particular emphasis is given to a method for critically appraising papers that emphasizes validity, importance, and clinical applicability. Resources (including Web sites) for further learning are provided. J Am Diet Assoc. 2002;102:1263-1272.

Data Interpretation, Statistical↗
PubMed2003

An e-learning caregiving program for prostate cancer patients and family members.

e-health interventions have the potential to augment caregiving training for management of chronic disease. Instruction on caregiving functions often key to patients and families' well being is time consuming but not reimbursable in our current health care system. A theoretically defined interactive multimedia program is described which would assess patient and family member's level of preparedness for specific caregiving functions for prostate cancer and provide tailored skill building vignettes on caregiving techniques. Maximizing today's technology, this program is best designed for a hybrid delivery utilizing both web-based resources and a CD-ROM. Feedback from 45 prostate patients and family members from a Midwest cancer center on perceived needs for caregiving training underscores the potential value of a computer supported intervention for some patients and families. Implementation of the software, marketing, and distribution will be guided in part by recent e-health experiences that leave many health professionals appropriately skeptical about the utility of such products.

Caregivers↗
PubMed2003

Evidence-based medicine and psychiatric practice.

Evidence-based medicine (EBM) has been defined as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." EBM requires the ability to apply a knowledge of medical informatics (e.g., efficiently searching the medical literature) and clinical epidemiology (e.g., being able to critically appraise the literature) to the treatment of individual patients. This article provides an introduction to the history, philosophy, and methods of EBM as applied to psychiatric practice. The article summarizes the five-step EBM model: (1) formulate the question; (2) search for answers; (3) appraise the evidence; (4) apply the results; and (5) assess the outcome. Resources (including Web sites) for further learning are provided.

Clinical Competence↗
PubMed2004

E-neuroscience: challenges and triumphs in integrating distributed data from molecules to brains.

Imaging, from magnetic resonance imaging (MRI) to localization of specific macromolecules by microscopies, has been one of the driving forces behind neuroinformatics efforts of the past decade. Many web-accessible resources have been created, ranging from simple data collections to highly structured databases. Although many challenges remain in adapting neuroscience to the new electronic forum envisioned by neuroinformatics proponents, these efforts have succeeded in formalizing the requirements for effective data sharing and data integration across multiple sources. In this perspective, we discuss the importance of spatial systems and ontologies for proper modeling of neuroscience data and their use in a large-scale data integration effort, the Biomedical Informatics Research Network (BIRN).

Animals↗
PubMed2002

Deliberate release of biological agents.

Deliberate release of biological agents is a growing threat, but clinical recognition of the resulting diseases is hampered by their rarity and similar presentation to more common illnesses. Despite substantial publicity, access to information may be difficult. Further, the available data are fragmented and not always relevant to critical care settings. We describe the clinical presentations of some important infections, highlighting the features that are relevant to critically ill patients. We provide an integrated set of guidelines for diagnosis, patient care and infection control and have attempted to list important print- and web-based resources for further information.

Bioterrorism↗
PubMed2003

DARTS 2000 online diabetes management system: formative evaluation in clinical practice.

RATIONALE, AIMS AND OBJECTIVES: Failure to engage in user-informed evaluation of emergent health informatics tools can have negative consequences for future implementation, related both to poor usability or clinical utility and to suboptimal stakeholder buy-in. This paper describes a formative evaluation in primary care of a multifaceted, web-based resource for diabetes management. The primary aims were to assess the usability and utility of the prototype in order to inform system refinements prior to implementation, and to investigate barriers and facilitators to system use so as to aid the development of a tailored implementation plan. METHODS: A mixed-method approach involving survey, remote observation, semi-structured interviews and electronic feedback. CONTEXT: One Scottish local health care cooperative comprising five general practice surgeries and their staff. RESULTS: A survey following temporary exposure to a dummy site revealed high levels of computer familiarity, welcoming attitudes and positive ratings of usability, format and utility. Comments mainly addressed content accuracy, feature suggestions and usability issues. Key barriers and facilitators to use included time and training. Remote observation following access to live clinical data enabled profiling of usage by individual and professional group. In the 3 month observation period administrators were the most frequent users, followed by GPs and nurses, with clinical and data entry screens accessed most often. Semi-structured interviews with key respondents sampled by professional group and usage frequency provided richer qualitative information on barriers and facilitators to use, patterns of system integration into work routines and system usability, content and utility. Content analysis of electronic feedback revealed mainly technical queries and general expressions of satisfaction. CONCLUSIONS: Evaluation informed a number of important and unforeseen improvements to the prototype and helped refine the implementation plan. Engagement in the process of evaluation has led to high levels of stakeholder ownership and widespread implementation.

Attitude to Computers↗
PubMed2004

Changes in student approaches to learning with the introduction of computer-supported problem-based learning.

OBJECTIVES: To study changes in student approaches to learning following the introduction of computer-supported, problem-based learning. SETTING: Medical students at the University of Oslo undertake a 12-week period of clinical placement during their 10th term. In this period they continue to undertake problem-based learning (PBL) in the form of distributed problem-based learning (DPBL) in a computer-supported learning environment. DESIGN: A questionnaire focusing on learning styles, PBL, and information and communication technology (ICT) was distributed before and after the DPBL period. SUBJECTS: All students in their 10th term at the University of Oslo (n = 61). RESULTS: The introduction of DPBL did not seem to affect the participants' use of regulating strategies or their mental models of learning. After the DPBL period, group discussion and tutor input were reported to have less influence on students' self-study, while the students perceived themselves as being less active in groups and as expecting less from tutors. There was a relationship between perceived tutor influence and students' familiarity with ICT. The DPBL period seemed to increase students' task-related web accesses and use of experts, and to decrease their task-related use of textbooks and discussions with students outside the group. CONCLUSIONS: Students' general approaches to learning were not affected by the introduction of DPBL. However, there was a decrease in students' expectations concerning activity in the group and the importance of the tutor. These changes were related to students' familiarity with the use of computers. Web-based resources and experts became more important resources to the students during the DPBL period.

Adult↗
PubMed2002

Shared decision-making strategies for early prostate cancer.

Prostate cancer remains one of the most prevalent and least understood of all human malignancies. Pathologic evidence suggests that neoplastic changes of the prostate epithelium begin early in a man's adult life, but do not become clinically evident or relevant until decades later. The natural history of this enigmatic disease is heterogeneous, ranging from a benign and indolent course to one that rapidly progresses, causing significant morbidity and mortality. The divergent aspects of prostate cancer are underscored by vast differences in incidence and mortality statistics, causing consternation among clinicians and patients regarding the relative value of early detection, screening, and treatment strategies. Competing risks and perceived benefits of proposed treatment options including surgery, radiation therapy, hormonal deprivation, watchful waiting, and newer technologies are complex. Given these uncertainties, how should patients integrate these data and what role must physicians play in the process? Here we present a summary of shared decision making for men with localized prostate cancer. We approach this task by using a clinical case scenario to discuss issues relating to incidence and mortality trends, uncertainty regarding natural history, biopsy techniques and concerns, relevant tumor and clinical data, patient information gathering through Web-based resources, as well as support and advocacy groups, outcomes implications, and methods patients use to approach treatment decisions. We present a unified platform for shared decision-making strategies regarding prostate cancer in clinical practice.

Decision Making↗
PubMed2001

Violence in A&E departments: a systematic review of the literature.

Violence against A&E staff is increasing, and national initiatives have been implemented to counter the threat to staff. The aim of this paper is to determine the risks to staff of working in A&E and to determine methods of risk-reduction, using searches of literature and web-based resources. There is also critical appraisal of the data therein.

Emergency Service, Hospital↗
PubMed2002

Psychological cue use and implications for a clinical decision support system.

Effective clinical decision making depends upon identifying possible outcomes for a patient, selecting relevant cues, and processing the cues to arrive at accurate judgements of each outcome's probability of occurrence. These activities can be considered as classification tasks. This paper describes a new model of psychological classification that explains how people use cues to determine class or outcome likelihoods. It proposes that clinicians respond to conditional probabilities of outcomes given cues and that these probabilities compete with each other for influence on classification. The model explains why people appear to respond to base rates inappropriately, thereby overestimating the occurrence of rare categories, and a clinical example is provided for predicting suicide risk. The model makes an effective representation for expert clinical judgements and its psychological validity enables it to generate explanations in a form that is comprehensible to clinicians. It is a strong candidate for incorporation within a decision support system for mental-health risk assessment, where it can link with statistical and pattern recognition tools applied to a database of patients. The symbiotic combination of empirical evidence and clinical expertise can provide an important web-based resource for risk assessment, including multi-disciplinary education and training.

Bias↗