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Information-seeking behavior of nursing students and clinical nurses: implications for health sciences librarians.

OBJECTIVES: This research was conducted to provide new insights on clinical nurses' and nursing students' current use of health resources and libraries and deterrents to their retrieval of electronic clinical information, exploring implications from these findings for health sciences librarians. METHODS: Questionnaires, interviews, and observations were used to collect data from twenty-five nursing students and twenty-five clinical nurses. RESULTS: Nursing students and clinical nurses were most likely to rely on colleagues and books for medical information, while other resources they frequently cited included personal digital assistants, electronic journals and books, and drug representatives. Significantly more nursing students than clinical nurses used online databases, including CINAHL and PubMed, to locate health information, and nursing students were more likely than clinical nurses to report performing a database search at least one to five times a week. CONCLUSIONS AND RECOMMENDATIONS: Nursing students made more use of all available resources and were better trained than clinical nurses, but both groups lacked database-searching skills. Participants were eager for more patient care information, more database training, and better computer skills; therefore, health sciences librarians have the opportunity to meet the nurses' information needs and improve nurses' clinical information-seeking behavior.

Adult↗

Evaluation of diffuse technologies: the case of digital imaging networks.

There have been significant developments in recent years in the methodologies and methods for the evaluation of a wide range of health technologies. There remain, though, many technologies which are difficult to evaluate. Often the difficulty stems from the complexity of the technologies themselves, which are in effect hybrids, comprising combinations of several distinct elements. In this paper these are termed 'diffuse' technologies, because the different elements exert different costs and effects, often across several different services. Computer networks are one, increasingly important, example of such technologies in health care. While it is possible to evaluate individual elements of such technologies, it is not clear how to evaluate the technology as a whole, where the whole may be greater (or less) than the sum of the parts. The paper outlines a seven-stage framework for the evaluation of diffuse technologies. The general principles of evaluation are illustrated using the example of picture archiving and communication systems (PACS), which are computer systems designed to capture, store and distribute electronic radiological images within a hospital.

Cost-Benefit Analysis↗

Using a personal digital assistant to document clinical pharmacy services in an intensive care unit.

Management Case Studies describe approaches to real-life management problems in health systems. Each installment is a brief description of a problem and how it was dealt with. The cases are intended to help readers deal with similar experiences in their own work sites. Problem solving, not hypothesis testing, is emphasized. Successful resolution of the management issue is not a criterion for publication--important lessons can be learned from failures, too.

British Columbia↗

Prevalence and predictors of pathological gambling: results from the St. Louis personality, health and lifestyle (SLPHL) study.

OBJECTIVES: We report the prevalence of and risk and protective factors for DSM-IV sub-threshold gambling (1-4 criteria) and pathological gambling disorder (PGD; 5-10 criteria) in a non-clinical household sample of St. Louis area gamblers. METHODS: Of the 7689 individuals contacted via Random Digit Dialing, 3292 were screened eligible. Of these, 1142 from households in 6 contiguous regions in Missouri and Illinois consented to participate and were mailed a St. Louis Area Personality, Health, and Lifestyle (SLPHL) Survey. RESULTS: Post-stratification weighted data (n=913) indicate lifetime prevalence rates of 12.4% sub-threshold and 2.5% PGD (conditional prevalence=21.5% and 4.3% respectively). Risk and protective factors for gambling severity varied in the sample. CONCLUSIONS: Targeted prevention messages are warranted specifically for gamblers of varying risk for PGD.

Adolescent↗

Primary health care ICD--a tool for general practice research.

The International Classification of Diseases (ICD) has become the only diagnostic classification system of international standard that allows reliable comparisons of epidemiological data between countries, parts of a country, levels of health care systems, or different periods of time. However, for primary health care purposes it is too specific to describe problems relevant to the work of general practitioners (GPs). Tools are thus needed to 'compress' data in primary health care for educational, administrative and research purposes. The objective of this paper was to introduce a diagnosis coding system that can be used in primary health care settings for these purposes. Principal diagnoses, as assessed by medical doctors, were collected from 20,648 patient visits. After primary coding, according to the ICD on a five-digit scale, the diagnoses were grouped into larger entities, which reduced the number of diagnoses to one eighth of the original number. The ten most common original five-digit diagnoses accounted for one quarter of all consultations, whereas the ten most common diagnoses counted for one half of all consultations after compressing the data into new categories. Analysing epidemiological data in the records of primary health care by the ICD offers benefits because of the latter's wide use. These are discussed below.

Adult↗

The role of clinical information systems in health care quality improvement.

This article addresses the increasing use of electronic medical records and supporting clinical information systems in US hospitals. It also addresses the current barriers to implementation of digital technology, which include cost, cultural factors, and the reluctance to embrace new technology. However, despite the barriers, there is evidence from the Veteran's Administration, Partners' HealthCare, Kaiser Permanente, and other organizations that electronic medical records and clinical information systems are a worthwhile investment. The benefits of the electronic medical records include the reduction of errors, improvement in clinical decision making during patient encounters, and universal access to information in real time. From a managerial perspective, health care organizations should adopt such systems to improve quality of care and to stay competitive in the marketplace. From a policy perspective, the electronic medical record provides an opportunity for integration of patient information and improves efficiency and quality of care across a wide range of patient populations.

Hospital Information Systems↗

Advancing cancer detection and treatment using longitudinal routine clinical data.

Cancer management remains fragmented across its continuum, from late-stage diagnosis and salvage therapies to non-personalized surveillance. Here, we present Oncoformer, a unified multimodal transformer model trained on the China Oncology Multimodal Prediction and Surveillance Study (COMPASS) cohort (3.67 million individuals, 17.7 million clinical visits) and validated on independent external cohorts, including the UK Biobank. Oncoformer integrates longitudinal electronic health records with chest X-ray imaging to address multiple clinical tasks: pan-cancer diagnosis (area under the receiver operating characteristic curve [AUROC] = 0.956), future cancer prediction up to 1 year before diagnosis (AUROC = 0.869), tumor stage inference (mean AUROC > 0.90), patient-specific treatment-response forecasting, and recurrence-free survival stratification across ten cancer types (all p < 0.01). Staging predictions were independently validated against postoperative pathological endpoints and shown to converge on core cancer genomic pathways. By translating routine clinical data into a dynamic view of cancer evolution, Oncoformer provides a framework for risk-informed cancer prediction and treatment stratification using routine clinical data.

Humans↗

Filmless medical imaging: experiences of the Massachusetts General Hospital.

As the concept of picture archival communication systems (PACS) gathers momentum, the vision of a filmless digital department and digital image management has become a reality. This report will discuss the experiences of a major health-care institution with implementation of a large-scale PACS. Specifically, we discuss success with a modular, nonproprietary, multivendor solution that offers flexibility and state of the art functionality at our institution.

Hospitals, General↗

Easy and effective--web-based information systems designed and maintained by physicians: experience with two gynecological projects.

It is well established that medical information sources develop continuously from printed media to digital online sources. To demonstrate effectiveness and feasibility of decentralized performed web-based information sources for health professionals, two projects are described. The information platform of the German Working Group for Information Technologies in Gynecology and Obstetrics (AIG) and the information source concerning the German Registry for in vitro fertilization (DIR) were implemented using ordinary software and standard computer equipment. Only minimal resources and training were necessary to perform safe and reliable web-based information sources with a high correlation of effectiveness in costs and time exposure.

Data Collection↗

Analysis of the thickness and curvature of articular cartilage of the femoral condyle.

PURPOSE: To develop an optimal autologous osteochondral transplantation technique, we analyzed the thickness and curvature of the femoral condyle. TYPE OF STUDY: Basic research for surgical technique, anatomic study. METHODS: Eight cadaveric femoral condyles were sectioned sagittally into 8 slices. Photographs of each slice were digitized, and the thickness and curvature of the overlaying cartilage were analyzed using a National Institutes of Health image program. RESULTS: The average thickness of the cartilage was 1.69 mm. The minimum and maximum values were measured at 0.22 mm and 3.65 mm, respectively, with the thinnest part seen in the sulcus terminalis (the groove for meniscus). The average curvature of the cartilage was 4.4 m(-1). The minimum and maximum values were measured at -20.0 m(-1) and 27.2 m(-1), respectively. CONCLUSIONS: When the chondral lesion is assumed at the weight bearing area of the medial or lateral femoral condyle, the anterior portion of the sulcus terminalis (the groove for meniscus) in the middle section of the lateral condyle is considered to be the optimal donor site.

Aged↗

Ethnic differences in distribution of serum prostate-specific antigen: a study in a healthy Chinese male population.

OBJECTIVES: To evaluate the normal distribution of serum prostate-specific antigen (PSA) levels in healthy Chinese men, because, until recently, studies conducted to establish normal serum PSA values have not involved a Chinese population. METHODS: Between September 1999 and December 2001, 1096 healthy Chinese men aged 23 to 85 years, who had undergone a routine health examination, were recruited to this study. All underwent detailed clinical examinations, including serum PSA determination and digital rectal examination. All men with abnormal digital rectal examination findings and/or an abnormal serum PSA level (greater than 4.0 ng/mL) underwent transrectal ultrasound-guided sextant biopsy. RESULTS: The median serum PSA concentration was 0.50 ng/mL (95th percentile 1.20) for men 23 to 29 years old (n = 77); 0.55 ng/mL (95th percentile 1.21) for men 30 to 39 years old (n = 189); 0.54 ng/mL (95th percentile 1.23) for men 40 to 49 years old (n = 233); 0.82 ng/mL (95th percentile 2.35) for men 50 to 59 years old (n = 177); 0.93 ng/mL (95th percentile 3.20) for men 60 to 69 years old (n = 265); and 1.17 ng/mL (95th percentile 3.39) for men 70 years old or older (n = 155). The serum PSA concentration correlated with age (P <0.001), with an increase of approximately 1.1% annually. No change occurred in the median serum PSA value and 95th percentile in men younger than 50 years old; a gradual increase was observed in men older than 50 years. In those 50 years old or older, the median and 95th percentile serum PSA values for Chinese men were significantly lower than those for other races and even for other Asian men. CONCLUSIONS: These findings further confirm that the serum PSA level correlates with age. Moreover, the distribution and cutoff value of the serum PSA level differs along ethnic lines. In addition, our findings raise the question of whether lowering the PSA cutoff may enhance the detection of cancer in Chinese men who have the lowest prostate cancer rate.

Adult↗