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PubMedDate not supplied

Evaluating IAIMS at Yale: information access.

OBJECTIVE: To evaluate use of information resources during the first year of IAIMS implementation at the Yale-New Haven Medical Center. The evaluation asked: (1) Which information resources are being used? (2) Who uses information resources? (3) Where are information resources used? (4) Are multiple sources of information being integrated? DESIGN: Measures included monthly usage data for resources delivered network-wide, in the Medical Library, and in the Hospital; online surveys of library workstation users; an annual survey of a random, stratified sample of Medical Center faculty, postdoctoral trainees, students, nurses, residents, and managerial and professional staff; and user comments. RESULTS: Eighty-three percent of the Medical Center community use networked information resources, and use of resources is increasing. Both status (faculty, student, nurse, etc.) and mission (teaching, research, patient care) affect use of individual resources. Eighty-eight percent of people use computers in more than one location, and increases in usage of traditional library resources such as MEDLINE are due to increased access from outside the Library. Both survey and usage data suggest that people are using multiple resources during the same information seeking session. CONCLUSIONS: Almost all of the Medical Center community is using networked information resources in more settings. It is necessary to support increased demand for information access from remote locations and to specific populations, such as nurses. People are integrating information from multiple sources, but true integration within information systems is just beginning. Other institutions are advised to incorporate pragmatic evaluation into their IAIMS activities and to share evaluation results with decision-makers.

Academic Medical Centers↗
PubMed1988

Informal communication networks and change in physicians' practice behavior.

This study used influential physicians to disseminate information concerning the advantages of developing and using computer-stored personal order sets with a hospital information system. The results indicate that continuing medical education delivered through influential physicians is an effective way of changing physicians' practice behavior.

Communication↗
PubMedDate not supplied

Home health case management: rural caregiving.

Providing home health services to a rural population can be a challenge to the home health nurse. Resources are limited in the rural environment as compared with the more populated urban areas. To fill the gap between the needs of the patients and available healthcare resources, informal networks are developed within the patient's support system. These informal networks are often made up of family members, friends, and relatives. The home health nurse has multiple tasks to complete when assisting/enabling the patients and families to become independent in the care required. The use of a three-model approach in home health practice (Collaborative Practice Model, Multisystem Model, and Family Caregiving Model) can produce a system in which a high quality of care is given to the rural population, thereby meeting the needs of the community and patient.

Aged↗
PubMed1999

Using sensitivity analysis for efficient quantification of a belief network.

Sensitivity analysis is a method to investigate the effects of varying a model's parameters on its predictions. It was recently suggested as a suitable means to facilitate quantifying the joint probability distribution of a Bayesian belief network. This article presents practical experience with performing sensitivity analyses on a belief network in the field of medical prognosis and treatment planning. Three network quantifications with different levels of informedness were constructed. Two poorly-informed quantifications were improved by replacing the most influential parameters with the corresponding parameter estimates from the well-informed network quantification; these influential parameters were found by performing one-way sensitivity analyses. Subsequently, the results of the replacements were investigated by comparing network predictions. It was found that it may be sufficient to gather a limited number of highly-informed network parameters to obtain a satisfying network quantification. It is therefore concluded that sensitivity analysis can be used to improve the efficiency of quantifying a belief network.

Algorithms↗
PubMed2001

Securing interoperability between chip card based medical information systems and health networks.

Health information systems supporting shared care are going to be distributed and interoperable. Dealing with sensitive personal medical information, such information systems have to provide appropriate security services, allowing only authorised users restricted access rights to the patients' data according to the 'need to know' principle. Especially in healthcare, chip card based information systems occur in the shape of patient data cards providing informational self determination and mobility of the users as well as quality, integrity, accountability, and availability of the data stored on the card, thus improving the shared care of patients. The DIABCARD project aims at the implementation and evaluation of a chip card based medical information system (CCMIS) for facilitating communication and co-operation between health professionals in different organisations or departments caring the same patient with diabetes as an example. In co-operation with the EC-funded TrustHealth(2) project, communication and application security services needed are provided like strong authentication as well as the derived services such as authorisation, access control, accountability, confidentiality, etc. The solution is based on Health Professional Cards and Trusted Third Party services. In addition to the secure handling of the patient's chip card and data in DIABCARD workstations, the secure communication between these workstations and related departmental systems has been implemented. Based on the results of this feasibility study, an enhanced security services specification for the DIABCARD example of a CCMIS is provided which will be implemented in the framework of a health network being established in the German federal state Bavaria. Beside the preferred solution of a combination of Patient Identification Card and Patient Data Card, lower level alternatives using card-verifiable certificates are explained in some details. Finally, a few legal issues, future trends like the XML standard set and their implications for the solution presented as well as for distributed health information systems in general are shortly discussed.

Computer Security↗
PubMed1999

Demographic and attitudinal variables related to high-risk behaviors in Asian males who have sex with other men.

Although AIDS is spreading rapidly in minority communities, little is known about attitudes, knowledge, and behavior related to AIDS and HIV in the Asian community. The purpose of this study was to examine these variables in a sample of gay Asian males, as well as to investigate the relationship between knowledge, sources of information, culturally influenced attitudes and high-risk behaviors in this population. Results from a sample of 60 young Asian men who self-identified as "having sex with other men" indicated they were generally knowledgeable about methods of transmission and prevention, and appeared linked to a large information network that included informal sources such as peers and formal sources. However, significant percentages held culturally biased views of AIDS, such as believing race of partner or one's own gender role in the sexual encounter determined level of risk; and one third of the sample did not use condoms regularly. Having been tested for HIV was associated with holding less traditional cultural beliefs and a higher sexual activity level. Open communication about safer sexual practices was associated with monogamous as opposed to multiple relationships and with decreased tendency to engage in alcohol-related unprotected sex. Variance in overall risk was predicted by demographic variables such as education, age, and level of sexual activity, rather than by the attitudinal factors measured. Limitations of this exploratory study include a time-limited subject recruitment period and consequent small sample size, a homogeneous sample weighted toward young, well-educated, and middle-class respondents, and the exclusion of non-English speaking individuals. Nevertheless, study findings suggest that educational outreach targeting Asians who have sex with other men needs to address inaccurate cultural beliefs about HIV/AIDS, emphasize consistent condom use, and encourage models of open communication with partners about safer sexual practices.

Adolescent↗
PubMedDate not supplied

Arkansas experience: between the government & the private sector.

Officials in many communities, states and regions are trying to establish networks to electronically exchange administrative and clinical data. Today, however, few examples of truly operational healthcare information networks (HINs) exist. Because of governance, control and cost, efforts toward integrating clinical information have not progressed. These issues are most apparent in the struggle to establish community health information networks (CHINs).

Arkansas↗
PubMed2003

The association between corticosteroid use and development of fractures among IBD patients in a population-based database.

OBJECTIVES: Because the rate of fracture among patients with inflammatory bowel disease (IBD) is only slightly higher than that in the general population, it is important to define high-risk groups worthy of diagnostic evaluation or prophylactic interventions. Corticosteroid use has been considered in other diseases to be a risk for fracture, although not all studies in IBD are concordant on this point. We aimed to determine whether patients with IBD drawn from a population-based database who sustain fractures are more likely to have been using corticosteroids than a matched group of IBD patients who did not fracture. METHODS: We extracted from our population-based University of Manitoba Inflammatory Bowel Disease Epidemiology Database the number of patients with a new diagnosis of fracture between the years 1997-2000. From within our Inflammatory Bowel Disease Epidemiology Database, we extracted a control group of IBD patients who did not develop fractures matched to the case group who did by age, gender, diagnosis, year of diagnosis, and geographic area of residence. We linked our cohorts with Manitoba Health's Drug Program Information Network to study corticosteroid use within 2 yr before fracture diagnosis. The Drug Program Information Network is a population-based database, established in 1995, which records all prescription drugs. RESULTS: Fractures were identified in 13 patients with Crohn's disease and in 28 patients with ulcerative colitis. The control group included 103 Crohn's disease and 173 ulcerative colitis patients who did not fracture. In Crohn's disease, for the group who fractured compared with the controls who did not fracture, corticosteroid use before fracture was evident in seven (54%) compared with 21 (22%) who did not fracture (chi(2) = 4.45, df = 1, p = 0.035). In ulcerative colitis, for the group who fractured compared with the controls who did not fracture, corticosteroid use before fracture was evident in five (18%) compared with 37 (21%) who did not fracture (chi(2) = 0.031, df = 1, p = 0.861). Fracture cases were more likely to be exposed to oral corticosteroids (OR = 1.75; 95% CI = 0.82-3.75), but this result is not significant. Regarding corticosteroid dosing among the 12 patients with IBD who fractured and used corticosteroids, the mean total days supply was 314 days +/- 236 days compared with 258 days +/- 278 days in those who did not fracture (p = 0.16). The prescribed daily dose among corticosteroid users was comparable for those who fractured versus those who did not fracture (18 mg/day vs 21 mg/day, p = 0.90). CONCLUSIONS: Patients who require corticosteroids in Crohn's disease should be considered at risk for fracture. Further research is required to delineate after how much corticosteroid use are subjects at risk and/or after what duration of active disease.

Adult↗
PubMedDate not supplied

How people obtain their health information--a survey in two Pennsylvania counties.

A sample of 182 respondents to a mail survey in two Pennsylvania counties, one rural, one urban, provided information on the sources of their health information. Research questions addressed were from what sources did they obtain their health information, what differences were there in patterns of response between middle-aged and older residents, and how much did various subgroups use health information. Respondents indicated they received most of their health information from printed materials, television, and informal network members, in that order, with little difference between rural and urban respondents. Radio and organizations, such as unions, were less frequently used as health information sources. The amount of information received from printed materials decreased slightly with age for women, but decreased sharply for men. The amount of information received from TV decreased with age, especially for urban residents. The youngest and oldest groups reported receiving the most health information from printed materials. TV was the most common source of health information for middle-aged adults. The findings indicate that persons disseminating health information should target their efforts through printed materials, TV, and informal networks. The most frequently mentioned sources of health information were TV specials, news stories, magazines, news articles, publications, medical books, and physicians. Radio and organizations, used by large segments of the population, are relatively untapped in terms of their potential, and not fully used when available. The urban elderly appear to receive little health information from any source.

Adult↗
PubMed2006

Patterns in information strategies used by older men to understand and deal with prostate cancer: an application of the modélisation qualitative research design.

BACKGROUND: The increasing need of older individuals to safely self-manage their chronic illnesses requires that they clearly understand health-related information. Thus, this study examined health literacy as lived by men with prostate cancer (PC), rather than as assessed by professionals. OBJECTIVES: This study aimed to describe, analyse, and understand informational strategies of men with PC. The main objective was to describe these strategies according to self-assessed levels of functional health literacy and thus create an inventory of strategy characteristics. DESIGN: The modélisation qualitative research design framed this inquiry. SETTINGS: Montreal and Laval, province of Québec, Canada. PARTICIPANTS: The purposive sample comprised 15 French-Canadian men aged 61-83, most of whom were enroled in a PC support group. Recruitment and selection was assisted by the support group's chairman and a volunteer recruiter. Selection criteria were medical diagnosis of localised PC, childhood spent in Québec, ability to self-assess functional health literacy, effective oral communication in French, no use of psychotropic drugs, and normal time and space orientation. METHODS: Data collection involved semi-structured interviews and drawing of genograms and ecomaps. The qualitative-data-analysis software Atlas. ti (Version 4.1 for Windows) was used to code the interview data. Findings were also subjected to content analysis. Six volunteers examined and confirmed the authors' interpretation of the findings. RESULTS: Functional health literacy was cultivated throughout participants' lives and nourished by their social and cultural resources. A history of reading at home, interest in learning, supportive family and elementary school environments developed open-minded, critical-information-seeking older men. The findings did not support any association among formal education, level of health literacy, and ways of dealing with PC-related information. The construction of information networks provided participants with knowledge and with emotional and spiritual support to cope with PC. Men with different levels of health literacy had both unique and similar information strategies. CONCLUSIONS: Participants' decisions to adopt specific information strategies were influenced by awareness of impacts of PC on men's lives, construction and maintenance of information networks, as well as participants' critique of health information. Through their information strategies, participants regained decision-making power over their bodies and destinies, and then redefined their social roles.

Aged↗
PubMed1997

Information for trained nurses in remote areas: do electronically networked resources provide an answer?

This paper reports on a research project which examined the potential of the Internet, and other networked information resources, to improve access to information for trained nurses working in remote areas. This paper provides a review of current literature in the field. It describes the research carried out, presents a summary of the research findings and discusses the implications of these findings. The paper concludes that the Internet and networked resources do have considerable potential to improve access to information for nurses working in remote and rural areas. However, information skills, along with professional guidance, are also required.

Community Health Services↗