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Use of guidelines in primary care--practitioners' perspectives.

BACKGROUND AND OBJECTIVES: Concern about the inadequate take-up of guidelines in general practice has concentrated on problems arising from the process of their development and implementation. However, these perspectives fail to take account of the needs, attitudes and problems of GPs themselves. In this study we aimed to identify barriers to the use of guidelines and opportunities for tackling them, from the point of view of the GP, so that future guideline development and policy could be more sensitive to the needs of GPs in the environment in which they work. METHOD: Twenty in-depth semi-structured interviews were audiotaped with GPs from within the Avon Health Authority area, representing GPs with different backgrounds and working environments. The transcribed data collected were analysed using a grounded theory approach. RESULTS: Utilization of guideline information is complex. GPs' appraisals of the value of guidelines interact with prior knowledge and beliefs, practicalities of existing information storage and retrieval systems, and individual working practices. Conditions where guidelines are most likely to be referred to may be those either very rarely or very commonly presenting in general practice. Key issues for the uptake of guidelines in the consultation are: general preference for certain formats of presentation; reputability and ownership; use of guidelines in shared decision-making; scope for computer-based systems; and GPs' attitudes to time pressures on information-seeking in relation to tolerance of uncertainty. CONCLUSION: Local initiatives might usefully explore the possibilities of supporting development of guideline-retrieval systems customized for individual GPs or practices. Novel means of stimulating 'ownership' and demonstrating reputability should be sought. The analysis provides a framework for understanding the complexities of the processes of GPs' use of guidelines in practice which can be useful in explaining the results of trials of guideline effectiveness. Guideline implementation occurs in the context of conflicting pressures for clinical autonomy and professional standardization and quality improvement.

Attitude of Health Personnel↗

MEDINFO--a medical information system.

The MEDINFO (MEDical INFOrmation) system is a general purpose computer-based information storage, retrieval, and analysis system. It is designed for a time sharing, on-line computer system for the rapid and easy creation, maintenance, and analysis of general data files. A wide variety of types of information may be used. These include numeric, categoric, text, date, and multiple-response. The file structure allows several sets of data, including date-orientated data, to be used. MEDINFO permits a study to be created, a description of the data made, data to be entered and updated into records, and for the data to be displayed or analyzed by the investigator without programmer intervention.

Computers↗

Comparison of alphabetic and phonetic retrieval of online drug information.

Alphabetic, phonetic, and combined alphabetic and phonetic methods of retrieving online drug information were compared. Twenty-four volunteers participated in the study representing four user groups: physicians, nurses, pharmacists, and nonhealth-care hospital staff. Each subject performed 150 searches, 50 by each retrieval method. Using the alphabetic method, drug information was retrievable only if the drug name was spelled correctly. Using the phonetic method, searches were conducted based on the phonetic spelling of requests (e.g., "symetadine" for cimetidine). The combined method used a phonetic search only after an initial alphabetic search was unsuccessful. The elapsed time between the first entry and an indication that the information had been found or could not be found was determined, and the number of drug names not found and the number of excess tries were counted. There were no significant differences in elapsed time among the three methods. Pharmacists had the shortest mean elapsed time and physicians the longest. The average number of excess tries using the phonetic system was a third of the number required using the alphabetic method. The number of drugs not found showed only slight differences among the three methods. The subjects found the desired information on the first try 67% of the time with the alphabetic method, 66% with the combined method, and 90% with the phonetic method. The phonetic method had an average of 75 matches versus 20 for the alphabetic and combined methods. These results support use of a combined alphabetic and phonetic system for retrieving drug information.

Drug Information Services↗

The development and practical use of information systems in the pharmaceutical industry.

To provide information on the efficacy, safety, and quality of medicine promptly and accurately, we have developed two databases: a literature database with numerical data, and a Drug Information database. By an easy-to-use, company-wide information network system, over 1,000 medical representatives in more than 80 offices throughout Japan can retrieve information. Information derived from the system is displayed on the terminal and the original documents are automatically output through a facsimile.

Databases, Bibliographic↗

Which brain regions are critically involved in the retrieval of old episodic memory?

Memory is two-sided like the head of Janus: it looks into the past (retrograde memory) and the future (anterograde memory). While current opinion assumes a strong anatomical interdigitation in the processing of either kind of memory, recent single case reports and results obtained with the positron emission tomographic subtraction method indicate the likely existence of a dissociation: regions of the limbic system are primarily engaged in the encoding of autobiographical and semantic information, while cortical areas in the orbitofrontal and anterolateral temporo-polar regions are principally engaged in information retrieval. Within this retrieval system the right hemisphere may subserve episodic memory retrieval, and the left retrieval from the knowledge system (semantic memory).

Amnesia, Retrograde↗

MITOMAP: a human mitochondrial genome database--1998 update.

We have continued to develop MITOMAP (http://www.gen.emory. edu/MITOMAP ), a comprehensive database for the human mitochondrial DNA (mtDNA). MITOMAP uses the mtDNA sequence as the unifying element for bringing together information on mitochondrial genome structure and function, pathogenic mutations and their clinical characteristics, population associated variation, and gene-gene interactions. Over the past year we have increased the degree of interlinking of MITOMAP information available on the web page, by using our generalized information management system, GENOME. As increasingly larger regions of the human genome are sequenced and characterized, the need for integrating such information is growing. Consequently, MITOMAP and GENOME provide a valuable reference for the mitochondrial biologist, in addition to being a model for the development of comprehensive, information storage and retrieval systems for other components of the human genome. This paper documents the changes to MITOMAP which have been implemented over the past year.

Computer Communication Networks↗

Managing care in an integrated delivery system via an Intranet.

The CareGroup Provider Service Network is a managed care contracting organization which provides central administrative services for over 1800 physicians and 200,000 managed care lives. Services include utilization management, disease management and credentialing for the entire network. The management model of the Provider Service Network empowers local physician groups with information and education. To meet the managed care information needs of the network, we implemented an intranet-based executive information system, PSNWeb, which retrieves data from a managed care data warehouse. The project required the integration of diverse technologies and development of a complex security/confidentiality infrastructure to deliver information to 8 major clinician groups, each with different information needs.

Computer Security↗

Searching information with a natural language dialogue system: a comparison of spoken vs. written modalities.

This paper examines the effects of spoken vs. written dialogue modalities on the effectiveness of information search with a computerized retrieval system. Forty-eight adults familiar with the use of computers were asked to carry out six information retrieval tasks, engaging with the system using either spoken or written communication. The written modality was more efficient with regard to the number of dialogue turns, length of interaction with the system and mental workload. Even though the turns lasted longer in the written mode, they appeared to yield less mental workload. Moreover, spoken and written dialogues did not differ as regards the use of pronouns and articles. The implications for the development of natural-language dialogue systems are discussed.

Adolescent↗

Database application of digital medical X-rays and labs: computerization, storage, retrieval, interpretation, and distribution.

Stenter lets the health care worker order an X-ray that is produced as a computer image rather than on flat film. The health care provider can be in any location with the correct equipment, and view the digital image. The dimensions of this discussion are extensive. The cost savings because of reduced media and storage cost is substantial. Health care quality can be improved because of the ability to obtain consultation via telemedicine and the enhanced ability to track medical problems over time via trends. The major downside is the limited cost imbursement system to pay for technology. Unfortunately, this may impact on the improved quality of care. In simple terms someone needs to pay for the technology and the quality of health care needs to be maintained or improved. The real cost to the health care systems needs to be correctly calculated and inappropriate charging kept to a minimum. Specific costs need to be kept in mind and the first is the cost for new staff or staff training. The number of health care providers that are able to read the X-ray can be enlarged remembering that only American Board Certified Radiologists are allowed to give the final recommendation. How do we view the cost of missing something? It could be argued that this risk will be reduced because of improved technology for obtaining the digital X-ray and improved enhancement software. One way to view this situation is to include technology, management, and organization. The cost and benefits occur through the interplay of all three dimensions. The development of digital imaging hardware and artificial intelligence software will demand change in the management and organization. The organization will require changes in its design to accommodate the technology as to support and resources. Management will evolve to include methods for control and monitoring this technology. Business processes and standard operating procedures will change to integrate the technology into the organization in the most effective and efficient manner.

Database Management Systems↗

[Development of medical emergency response system for accidents due to chemicals in Chongqing municipality].

OBJECTIVE: To plan and develop a Chongqing chemical accident rescue command system. METHODS: Based on the modes of leakage and diffusion of various poisonous gases and chemicals, different modes of injuries produced, and their appropriate rescue and treatments, also taking the following factors such as the condition of storage of chemicals, meteorological and geographic conditions, medical institutions and equipment, and their rescuing capacity into consideration, a plan was drafted to establish the rescue system. Real-time simulation technology, data analysis, evaluation technology and database technology were employed in the planning. Using Visual Studio 6.0 as the software development platform, this project aimed to design the software of an emergency command system for chemical accidents in Chongqing which could be operated with the Windows 2000/XP operating system. RESULTS: This system provided a dynamic scope of the endangered area, casualty number estimates, and recommendation of measures and a rescue plan for various chemical accidents. Furthermore, the system helped retrieve comprehensive information regarding the physical and chemical characteristics of more than 4 200 dangerous poisonous chemicals and their appropriate treatment modalities. CONCLUSION: This system is easy to operate with a friendly interface, functions rapidly and can provide real-time analysis with comparatively precise results. This system could satisfy the requirements of executing the command and the rescue of a chemical accident with good prospects of application.

Accidents↗

Implementation and deployment of healthcare management information system.

In the following article we present development of the Management Information System, an implementation of our own Data Warehouse, build on top of the existing Healthcare Information System. We discuss requirements and phases of development of the system, we present the structure of the system, the experiences with end users and obstacles that we met, as well as possible improvements end extensions of the system. The system is designed as a framework that works with workload measurement sub-systems, which are defined as multidimensional arrays, and are observed through different units of time. Each of the axis has several hierarchical structures build on top of it. Setting up the system is a difficult task, because it requires a good knowledge of organisational structure of a particular hospital. We used an incremental approach in defining the organisational structure. On top of the framework we build a user customisable graphical user interface, which enables different types of end users to efficiently use the system.

Data Collection↗

[Exploration for building PACS and RIS].

This article elaborates key points of the PACS and RIS project: its overall planning, implementation step by step, integration of PACS and HIS based on IHE, and the prudent selection of partners and so on.

Hospital Information Systems↗

National Library of Medicine: international cooperation for biomedical communications.

The international programs of the National Library of Medicine may vary in mechanism, but all share the common objective of improved medical research, education, and practice. They are a natural extension of domestic responsibilities and represent a sharing of time, talent, and resources. The programs may be service-oriented, cooperative efforts based on the computerized information storage and retrieval system (MEDLARS), or establishment of regional medical library programs. Policy and operational aspects are presented.

Computers↗