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PubMed2000

The Internet: a practical example of the use of new technology in the assessment of vancomycin use in pediatrics. The Pediatric Prevention Network.

BACKGROUND: The rapid emergence of both new infections and new technologies has revolutionized health care during the past 50 years. Increased use of the Internet has enabled health care professionals to educate, interact, and collaborate throughout the world in ways never before possible. Increased use of vancomycin has been associated with the emergence of organisms with decreased susceptibility to vancomycin, such as Enterococcus and staphylococcal species. The purpose of this article is to describe our experience using Internet technology to assess vancomycin use at children's hospitals in the United States. METHODS: A Web-based evaluation was developed and distributed on the Internet to 57 Pediatric Prevention Network hospitals. The evaluation was structured to collect summary statistics on vancomycin use and admissions data by service for 1997 and 1998. RESULTS: Twenty-four hospitals were able to provide archived vancomycin use and patient admissions data; completed evaluations were returned from 15 hospitals (62.5% response rate). Personnel at 6 (40%) hospitals completed the evaluation directly on the Internet. CONCLUSIONS: In our study, Internet technology facilitated a more efficient evaluation of vancomycin use, but fewer than half of the personnel at Pediatric Prevention Network hospitals completed the evaluation directly on the Internet. It is unclear whether personnel at these hospitals were limited in Internet access, support, or understanding. Efforts should be directed to educate health care personnel on the advantages of the Internet. Furthermore, many of the pharmacy databases used in our assessment were not standardized across hospitals nor systematically validated. Understanding that limitations still remain-within the source of the data studied, the health care system sampled, and the Internet tools available-is essential because the Internet offers health care professionals today a tool both to protect patients and to improve quality throughout the world.

Attitude to Computers↗
PubMed2001

Professional information about urinary incontinence on the World Wide Web: is it timely? Is it accurate?

OBJECTIVE: Access to timely and accurate information about urinary continence and incontinence is important to the assessment and treatment of adults with urinary incontinence. The aims of this study were to identify current Web sites containing information about urinary continence that are easily accessible to health care providers and to determine the timeliness and accuracy of the information included on these Web sites. METHODS: The World Wide Web was searched for sites devoted to health care provider information about urinary continence and incontinence. Two external content reviewers evaluated content in terms of timeliness and accuracy. A table outlining each sites credibility, content, and function was constructed. RESULTS: Two hundred sixty-five sites were located, but only 15 met the inclusion criteria. Readability levels ranged from 6.2 to 14.5 years. All sites provided links, and 53% had internal search engines. Most information located was accurate; however, some sites contained dated information. Forty percent of the sites were not dated, and thus determining the currency of the information was impossible. CONCLUSIONS: The World Wide Web is a valuable tool containing state-of-the-art knowledge about urinary continence that WOC nurses can use to educate themselves and others. However, using critical skills to evaluate the information posted on these and any other sites is essential.

Authorship↗
PubMed2004

Using nursing information systems to enhance quality service across multiple service providers.

This study explored the key requirements identified by stakeholders for the integration of Nursing Information Systems (NIS) in three public hospitals in the southern suburbs of Adelaide. The study used a qualitative approach of semi-structured interviews, focus groups, site visits to the hospitals and review of relevant literature to ascertain what participants saw as the necessary ingredients to create regional NIS. Study findings showed that the current NIS are not sustainable in terms of staffing levels, physical resources or the capacity of the two currently-used computer products to interface with newer generation products. A critical issue for adopting a regional model is the willingness of local sites to revise their current internal structures and functions. This restructuring towards a regionalised NIS would improve overall communication, education, security efficiency and sustainability.

Computer User Training↗
PubMed1999

Meeting the information needs of an evidence-based world.

There are many new and exciting health information developments in Australia today. However, there are also many gaps and problems in the information available to support evidence-based decision-making. For example, computerisation in health lags behind other industries. However, these problems should not prevent us using the available data to manage individual care and the health care system more effectively. It is fruitless to wait for a technological solution to all our problems. Educational and staff changes are needed to prepare health professionals and patients to use information to make evidence-based decisions and bring health care into the information age.

Australia↗
PubMed1997

Testing the self-efficacy-performance linkage of social-cognitive theory.

Past empirical research examining the relationship of self-efficacy perceptions and performance has had several limitations. Most studies were performed in the laboratory with tasks not directly related to individual work performance. As a consequence, many findings are not generalizable to individual work performance. This study tested the self-efficacy-performance model found in Bandura's social-cognitive theory in a work setting, with a sample of 776 American university employees, and with discriminant function analyses. Respondents indicated that performance with computers significantly predicted perceptions of high and low self-efficacy. Results provide additional support for social-cognitive theory as outlined by Bandura.

Adult↗
PubMed2004

Use of on-line evidence databases by Australian public health practitioners.

OBJECTIVE: To investigate use of a web-based portal, known as the Clinical Information Access Program (CIAP), and evidence databases in an Australian population health workforce. METHODS: Self-administered postal survey of 104 staff in a regional Division of Population Health in Sydney, Australia. The main outcome measures were CIAP use and organization support for CIAP use. Two thirds of the respondents agreed that using CIAP was a legitimate part of their practice. However, half agreed that staff were encouraged to use it. One in five respondents (21%) used CIAP weekly. CIAP use was significantly associated with medical qualification or, among non-medical staff, with having at least a Masters qualification. CIAP use was not associated with occupational category, gender, age, employment status nor years of experience. Use of specific evidence databases such as Cochrane also differed significantly by respondents' characteristics. CONCLUSIONS: There has been only partial uptake of on-line databases among this population health workforce, particularly according to attainment of relevant postgraduate qualifications. As CIAP is a resource for evidence-based practice, greater effort to increase its use is recommended to ensure population health does not fall behind hospital-based clinicians.

Adult↗
PubMed1997

Microcomputers in hospital epidemiology.

Computers can store, manage, and analyze large quantities of data. Thus, computers are an ideal tool for the modern practice of infection control. This article provides practical information for infection control personnel who must choose or upgrade a computer system.

Computer User Training↗
PubMed2005

Website review: diabetes insight--www.diabetes-insight.info.

In previous Diabetes Information Technology & WebWatch columns some different diabetes Websites have been highlighted. In this issue we focus on one particular site and use this to illustrate how such Internet-based repositories of information can provide important and useful resources for people with diabetes and their carers. Diabetes is perhaps unique in the fact that much of the day-to-day responsibility for care rests with individuals themselves. Successful therapy demands considerable understanding of the condition by the person with diabetes, or his or her carer, and this can only be made possible with access to appropriate information. Provision of information via a Website is now recognised to be cost-effective and convenient, available 24 hours a day, 365 days a year-and access to the Internet by the general public has grown rapidly in recent years. The increasing way in which the Internet is being used to supply individuals with tools and information for their self-care is exemplified by the Diabetes Insight Website (at: www.diabetes-insight.info).

Computer User Training↗
PubMed1995

The Georgia State Telemedicine Program: initiation, design, and plans.

This paper describes the genesis, implementation, and operation of the Georgia Statewide Telemedicine Program, a full-service system that provides a comprehensive range of clinical and consultative services to all residents of the state through a hub-and-spoke network. When completed, it will consist of several tertiary-care centers and a set of secondary hubs at medical centers throughout the state. Each hub will, in turn, serve several remote sites. The system enables connectivity throughout the network, and the overall coordination, implementation, and oversight is provided by the Center for Telemedicine at the Medical College of Georgia. The evolution of the system is described, together with lessons learned from the experience.

Academic Medical Centers↗
PubMed1997

Reliability of telemedicine examination.

OBJECTIVES: To assess the reliability of telemedicine examination and identify the issues to be addressed if the conduct of physical examination and the reading of images and tracings by telemedicine are to be as reliable as conventional examination and reading. METHODS: Patients were examined both conventionally and by telemedicine in 12 clinics, and the results were compared. There were 1826 matched pairs of observations. Cardiac auscultation, echocardiography, electrocardiography, electroencephalography, obstetric ultrasonography, ophthalmologic examination, physical therapy assessment, pulmonary auscultation, and the reading of chest radiographs with telemedicine cameras and monitors were studied. The main outcome measure was agreement between the telemedicine findings and a criterion standard. RESULTS: For ophthalmology, physical therapy, and cardiac auscultation, 91.2% of the conventional findings and 86.5% of the telemedicine findings were identical or similar to the criterion standard. The kappa coefficient on matched-pair analysis was 0.66. For pulmonary auscultation and reading of chest films with a telemedicine camera and monitor abnormalities were suppressed at default settings but subsequently revealed with extensive manipulation of system settings. For tracings and images, both conventional and telemedicine findings showed 92% reliability, with a kappa coefficient of 0.87. CONCLUSIONS: On the basis of these observations and the methods used, reliability varied with the type of examination, clinician experience with telemedicine, and participant knowledge of system limitations. Clinicians without experience or knowledge of system limitations missed findings of clinical importance. Improvements in equipment since the clinics were conducted in 1994 may have resolved some of these problems. Our findings raise doubts about the reliability of occasional telemedicine consultations by clinicians inexperienced in the technology.

Bias↗
PubMed1992

Attitudes toward younger and older adults learning to use computers.

Person perception and direct attitude paradigms were employed to examine age bias in the achievement-oriented setting of computer learning. Two samples of volunteers (80 undergraduates and 120 science museum visitors) evaluated a target person (a man or woman, aged either 25 or 70 years) described as being enrolled in a computer course and made causal attributions after outcome feedback. Age effects were significant, but gender effects were not observed. Older adults were considered less likely to succeed in the course and less typical for their age group, although the older course enrollees were viewed as more competent overall than their younger peers in the course. In the undergraduate sample only, causal attributions indicated that the success of older adults was less related to the task than for young adults, and that their failure was less related to lack of effort and more related to their age. Analyses of the direct attitude items yielded predictably stronger age effects in both studies, accounting for 61-80% of the variance.

Adolescent↗