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At least 883 records · Page 49Linked to original sources
PubMed2002

US military veterans' perceptions of the conventional medical care system and their use of complementary and alternative medicine.

BACKGROUND: Use of complementary and alternative medicine (CAM) is growing quickly in the USA, prompting hypotheses about why people turn to CAM. One reason for increasing use of CAM modalities may be dissatisfaction with the conventional care system. However, recent studies suggest that dissatisfaction is not a major factor. OBJECTIVES: This paper provides another perspective on the possible relationship between dissatisfaction with conventional care and the use of CAM. METHODS: Qualitative data collection, in the form of 12 focus groups with 100 CAM users, was used to inquire about issues surrounding the use of CAM. Focus group participants were military veterans enrolled in the Southern Arizona VA Health Care System, and their significant others. Qualitative analysis identified key themes emerging from the focus groups. RESULTS: Although participants were satisfied in general terms with their conventional care, there were particular aspects of the conventional care system that they criticized. Dissatisfaction with aspects of conventional care, particularly its reliance on prescription medications, was an important component in their motivation to use CAM. Results also suggest that the conventional medical system's lack of holism (inadequate information regarding diet, nutrition and exercise, and ignorance of social and spiritual dimensions) is also an important motivation for turning to CAM in this particular population. CONCLUSIONS: Independent research and a sense of responsibility on the part of focus group participants for their own health seemed to be taking them outside the domain of the conventional health care system.

Adult↗
PubMed1976

Public entry into emergency medical services systems.

The problems of public access to emergency medical services systems can decrease the effectiveness of emergency care. Much of the public is unable to recognize signs of serious illness, such as myocardial infarction, and dose not know how to obtain emergency medical help. In addition, emergency facilities and personnel are used for more non-emergency care than true emergency cases. Suggestions for the improvement of public access to emergency care include the use of telephones for triage and for providing information; ambulatory centers for non-emergency care; physician extenders such as paramedics or midwives, and improved systems of alerting emergency personnel that an emergency exists.

Ambulatory Care↗
PubMed1989

Heuristic determination of relevant diagnostic procedures in a medical expert system for gynecology.

Many professions including medicine have standard operating procedures for the performance of their tasks. In the construction of expert systems, knowledge engineers have exploited this fact in devising heuristic rules that mimic the standard practice among such personnel (i.e., experts). This article suggests that the expert system designer should not stop at the level of the standard operating procedure heuristic but should instead investigate the reasons that the standard procedures have become standard. Because the experts in a field often do not understand the reasons for the standard operating procedures of their profession, this effort not only rewards the system designer but the expert as well. Because medical training does not always emphasize the logical reasoning underlying certain standard operating procedures, the ability to perform this reasoning is especially important in medicine. Further, a medical expert system for consultation or education would make a valuable impact by incorporating such knowledge and inference rules. This article investigates the development of a computerized medical expert system that applies the principles of artificial intelligence by limiting the number of questions and tests to find the solution for an ill-defined complex problem. Finally, we describe a logic program that tests the basic ideas.

Artificial Intelligence↗
PubMedDate not supplied

Towards the morphology of medical information systems.

A review of research and development in the field of medical information systems shows that, on the whole, technical hardware and specific software problems have been the central consideration. Only recently has it been acknowledged that it is necessary to include the formerly neglected specific functional and organizational aspects. In this respect, morphological approaches enable new perspectives to be opened up for the analysis, design and classification of medical information systems.

Computers↗
PubMed1986

Modeling of a medical transcription system.

This article describes a methodology for modeling a medical transcription system by means of the discrete system computer simulation language, GPSS. Used on a personal computer, GPSS allows the medical record supervisor to explore numerous modes of operation and alternative transcription system configurations. Design and operating improvements that can be achieved by studying the performance of the model are also discussed.

Computers↗
PubMed1992

A study of evaluation methods for hospital medical care systems.

When we seek to evaluate hospital medical care services, we first collect data regarding the existing system in order to gather information and to develop a method of analysis that we can use for evaluation. We took the OPD system as an example, taking into account systematic OPD services based on queuing theory and computer simulation. As a result of the computer simulation model based on experimental conditions, we were able to offer recommendations for modifications of the present system that could improve patient service. The hospital manager can use this information to aid him in the decision making processes concerning the hospital. A study of the methods for the evaluation of hospital medical care services is important. It is necessary to develop a regional medical care information system as well as a hospital medical care information system.

Computer Simulation↗
PubMed2002

Comparative study in patients with microcalcifications: full-field digital mammography vs screen-film mammography.

The goal of this prospective study was to compare a full-field digital mammography system (FFDM) to a conventional screen-film mammography system (SFM) for the detection and characterization of microcalcifications. Fifty-five patients with 57 isolated microcalcification clusters were examined using a FFDM system (Senographe 2000D, GE Medical Systems, Milwaukee, Wis.) and a SFM system (Senographe DMR, GE Medical Systems, Milwaukee, Wis.). A conventional screen-film mammogram and a digital contact mammogram were obtained of each cluster. The image quality and the number of calcification particles were evaluated, and a characterization (BI-RADS 1-5) of microcalcifications was given by four experienced readers. Histopathology revealed 16 benign lesions (sclerosing adenosis, dysplasia, hamartoma, radial scar) in 15 patients and 21 malignant tumors (in situ carcinoma, invasive carcinoma) in 20 patients. Twenty patients had benign changes verified by long-term follow-up. Image quality of FFDM was assessed as superior to SFM in more than 50% of the cases. The FFDM showed more calcifications in 41% of all cases. Sensitivity and specificity for FFDM vs SFM were 95.2 vs 91.9% and 41.4 vs 39.3%, respectively. Moreover, FFDM demonstrated a higher diagnostic accuracy (deviation: 0.86 BI-RADS steps) compared with FSM (deviation 0.93 BI-RADS steps). The FFDM system with a 100- micro m pixel size provides better image quality than SFM in patients with mammographic microcalcifications. The FFDM has a higher sensitivity and a higher reliability in characterizing microcalcifications.

Breast Neoplasms↗
PubMed1982

The utility for audit of manual and computerized problem-oriented medical record systems.

Objective assessment of the delivery of care requires an unambiguous record of all related events and decisions in the care process. Both the handwritten Problem-Oriented Medical Record (POMR) and its computerized successor, the Problem Oriented Medical Information System (PROMIS) have been designed to facilitate audit of care delivery. In this study, a national sample of physicians was asked to determine which of these two record systems best serves the function of audit. The study involves assessment of a sample of 69 matched pairs of patient records drawn from two different ward settings, one of which used the manual POMR, the other, PROMIS. No difference was perceived between the two records with respect to the reliability of information or the analytical reasoning of providers. Information in PROMIS records was judged to be slightly more thorough. The format of the manual record was judged better on the basis of conciseness, accessibility, and organization of record information.

Computers↗
PubMed1998

Towards semantic integration within an existing medical information system.

Talking about the problems of integration in medical information systems, the necessity to provide end users with a consistent and coherent view of patient's data, has been largely reported. In order to attempt this goal, systems need to perform semantic integration. We propose a pragmatic way to describe the semantics of the elements of a database, based on a bottom-up three steps process: 1. a back documentation of the elements of the system from their description contained in the data catalog of the database 2. a first semantic extension to transform a data catalog into a data dictionary 3. a second semantic extension to create a dictionary of the medical concepts from a data dictionary. This dictionary of concepts can be considered as the final result of "semantic integration". It contains a set of entities directly understandable by the end users. These entities are deduced or built from the elements collected and characterized in the data dictionary. This work reports the conceptual analysis and the implementation of such a data dictionary.

Database Management Systems↗
PubMedDate not supplied

Confronting an outdated medical record system.

When a new administrator was hired for a group practice, a vintage medical record system (late 1940s) was standing firmly in the way of clinic efficiency and was creating significant medical and legal problems as well. The technical and political obstacles confronted by the administrator in designing, implementing, and monitoring a new medical record system are examined in this case study.

Florida↗
PubMed1991

[Five years' experience with new medical examiner's system in Tsukuba].

Medical examiner's system has been authorized by the act of Autopsy and preservation of corpses and the government ordinance for medical examiner's system since 1949 in Japan, and introduced only in five large cities (Tokyo metropolis, Osaka, Kobe, Yokohama, Nagoya). Recently in Ibaraki Prefecture, new forensic medical service system (Tsukuba Medical Examiner's office) was instituted. This new system is not authorized by the government ordinance, but authorized by the regional ordinance of Ibaraki prefectural governor, therefore this system is enforce only in Ibaraki prefecture. In our new system, medical examiner does not have discretionary power to order an autopsy, and family have a right to reject it, therefore an autopsy rate is very low (about 2%). One hundred and forty four autopsies have been conducted under this system. Ninety four of 144 autopsy cases (67%) were dead from sickness or natural death, in remaining 50 cases manner of death was accidental, suicidal or undetermined. The medical examiner does not conduct autopsies for criminal investigation or homicide cases in Ibaraki prefecture. These autopsies are conducted at the department of legal medicine, University of Tsukuba.

Autopsy↗