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PubMed2005

Patient preferences for notification of normal laboratory test results: a report from the ASIPS Collaborative.

BACKGROUND: Many medical errors occur during the laboratory testing process, including lost test results. Patient inquiry concerning results often represents the final safety net for locating lost results. This qualitative study sought to identify, from a patient perspective, specific preferences and factors that influence the process of communicating normal (negative) laboratory test results to patients. METHODS: We conducted 30-minute guided interviews with 20 adult patients. Patients were recruited from two practice-based research networks in Colorado that were participating in a medical errors study. A semi-structured interview elicited the participant's experience with and preference for laboratory test result notification. Quantitative descriptive statistics were generated for demographic and preference data. Qualitative results were analyzed by a team of experienced qualitative researchers using multiple styles of qualitative analyses, including a template approach and an editing approach. RESULTS: Ninety percent of participants wanted to be notified of all tests results. Important issues related to notification included privacy, responsive and interactive feedback, convenience, timeliness, and provision of details. Telephone notification was preferred, followed by regular mail. Electronic notification was perceived as uncomfortable because it was not secure. While 65% preferred being notified by a provider, participants acknowledge that this may be impractical; thus, they wanted to be notified by someone knowledgeable enough to answer questions. Participants do not normally discuss their preferences for test result notification with their providers. CONCLUSION: Privacy, responsive and interactive feedback, convenience, and timeliness with detailed information may be critical for patient satisfaction and for improving patient safety, and are features that may be incorporated into emerging communication channels.

Adult↗
PubMed1998

Integrating core information competencies into a traditional curriculum: a collaborative approach.

To prepare for a career, in which they keep up-to-date with current physical therapy procedures and health care trends, it is imperative that students become life-long learners. Four core competencies have been identified as skills to promote life-long learning: e-mail, professional electronic mailing lists (listservs), online data-base searching, and searching the World Wide Web. This paper discusses integrating the core competencies into the curriculum of a physical therapist assistant program through a collaborative effort between the physical therapist assistant program faculty and librarians.

Allied Health Personnel↗
PubMed2006

Communication systems in healthcare.

The care of patients now almost inevitably seems to involve many different individuals, all needing to share patient information and discuss their management. As a consequence there is increasing interest in, and use of, information and communication technologies to support health services. Yet, while there is significant discussion of, and investment in, information technologies, communication systems receive much less attention and the clinical adoption of even simpler services like voice-mail or electronic mail is still not commonplace in many health services. There remain enormous gaps in our broad understanding of the role of communication services in health care delivery. Laboratory medicine is perhaps even more poorly studied than many other areas, such as the interface between primary care and hospital services. Given this lack of specific information about laboratory communication services, this paper will step back and generally review the components of a communication system, including the basic concepts of a communication channel, service, device and interaction mode. The review will then try and summarise some of what is known about specific communication problems that arise across health services in the main, including the community and hospital service delivery.

Journal Article↗
PubMedDate not supplied

E-mail medicine: dawn of a new era in physician-patient communication.

Computer-based electronic mail has opened up new opportunities for physician-patient communication. In many ways, electronic communication is more convenient than either the telephone or the postal service. However, it is important to recognize the limitations of electronic mail. In this article, we review important issues and recommend minimal standards for physician-patient communication via electronic mail.

Communication↗
PubMed1996

The use of E-mail by otolaryngologists.

Electronic mail (e-mail) is an extremely powerful form of communication and the most frequently used application on the Internet. While e-mail is not the appropriate mode of communication for every situation, there are many instances where its use is invaluable.

Communication↗
PubMed1999

Feasibility of quality-of-life research on the Internet: a follow-up study.

OBJECTIVE: Assessment of the feasibility of conducting clinical research with patients using electronic mail and the World Wide Web. DESIGN: We re-contacted 463 patients with ulcerative colitis (UC) and 154 benign prostatic hyperplasia (BPH) patients who had provided us with e-mail addresses as part of a Web-based study. In an electronic mail message, we informed patients of a web site with a new study and invited them to participate. We then examined the factors associated with patients' participation in the new study. RESULTS: Completion rates were 28% for UC patients (single mailing) and 48% for BPH patients (up to four mailings in a two-month period). Some patients could not be contacted due to invalid e-mail addresses (23%). Those who completed the new study tended to be older, and less time had elapsed since their participation in the previous study. Furthermore, their health-related quality-of-life had significantly improved since the previous study. CONCLUSION: It is possible to use direct electronic mail contact to conduct follow-up research with patients. Response rates appear to be related to the number of messages sent, age of the recipients, and time since the initial contact.

Colitis, Ulcerative↗
PubMed1994

The Ribosomal Database Project.

The Ribosomal Database Project (RDP) is a curated database that offers ribosome-related data, analysis services, and associated computer programs. The offerings include phylogenetically ordered alignments of ribosomal RNA (rRNA) sequences, derived phylogenetic trees, rRNA secondary structure diagrams, and various software for handling, analyzing and displaying alignments and trees. The data are available via anonymous ftp (rdp.life.uiuc.edu), electronic mail (server/rdp.life.uiuc.edu) and gopher (rdpgopher.life.uiuc.edu). The electronic mail server also provides ribosomal probe checking, approximate phylogenetic placement of user-submitted sequences, screening for chimeric nature of newly sequenced rRNAs, and automated alignment.

Animals↗
PubMed1997

The RDP (Ribosomal Database Project).

The Ribosomal Database Project (RDP) is a curated database that offers ribosome-related data, analysis services and associated computer programs. The offerings include phylogenetically ordered alignments of ribosomal RNA (rRNA) sequences, derived phylogenetic trees, rRNA secondary structure diagrams, and various software for handling, analyzing and displaying alignments and trees. The data are available via anonymous FTP (rdp.life.uiuc.edu), electronic mail (server@rdp.life.uiuc.edu), gopher (rdpgopher.life.uiuc.edu) and WWW (http://rdpwww.life.uiuc.edu/ ). The electronic mail and WWW servers provide ribosomal probe checking, approximate phylogenetic placement of user-submitted sequences, screening for possible chimeric rRNA sequences, automated alignment, and a suggested placement of an unknown sequence on an existing phylogenetic tree.

Animals↗
PubMed1999

The Illness Intrusiveness Rating Scale: a measure of severity in individuals with hyperhidrosis.

OBJECTIVE: We estimated the reliability and validity of the Illness Intrusiveness Ratings Scale (IIRS) in hyperhidrosis, using an electronic mail form of administration. METHODS: Recent contributors to an electronic mail discussion group on hyperhidrosis responded to the IIRS, questions about surgical history, items designed to assess severity, and demographic questions, on two occasions four weeks apart. A variety of hypotheses regarding the relationships between these variables were constructed a priori. RESULTS: Sixty-eight people replied on two occasions. Internal consistency was high (Cronbach's alpha 0.88), as was test-retest reliability (kappa 0.89). The total IIRS score correlated with a global severity question (0.61; p < 0.001). Total IIRS score was lower in participants who had previously had surgery for hyperhidrosis, compared with those who had not (47 vs. 36; p = 0.02), and changed dramatically in the direction of diminished severity in four patients who underwent surgery during the course of the study (54 vs. 17; p = 0.01). Weak-to-moderate correlations were observed between total score and use of topical preparations, use of medications, number of clothing changes during a day, and limitations in choice of wardrobe. CONCLUSIONS: The IIRS is both reliable and valid in the assessment of patients with hyperhidrosis. A novel form of administration does not appear to affect its properties.

Adult↗
PubMed1993

The ribosomal database project.

The Ribosomal Database Project (RDP) is a curated database that offers ribosome data along with related programs and services. The offerings include phylogenetically ordered alignments of ribosomal RNA (rRNA) sequences, derived phylogenetic trees, rRNA secondary structure diagrams and various software packages for handling, analyzing and displaying alignments and trees. The data are available via ftp and electronic mail. Certain analytic services are also provided by the electronic mail server.

Databases, Factual↗
PubMed2000

Internet resources and web pages for pediatric surgeons.

The Internet, the largest network of connected computers, provides immediate, dynamic, and downloadable information. By re-architecturing the work place and becoming familiar with Internet resources, pediatric surgeons have anticipated the informatics capabilities of this computer-based technology creating a new vision of work and organization in such areas as patient care, teaching, and research. This review aims to highlight how Internet navigational technology can be a useful educational resource in pediatric surgery, examines web pages of interest, and defines ideas of network communication. Basic Internet resources are electronic mail, discussion groups, file transfer, and the Worldwide Web (WWW). Electronic mailing is the most useful resource extending the avenue of learning to an international audience through news or list-servers groups. Pediatric Surgery List Server, the most popular discussion group, is a constant forum for exchange of ideas, difficult cases, consensus on management, and development of our specialty. The WWW provides an all-in-one medium of text, image, sound, and video. Associations, departments, educational sites, organizations, peer-reviewed scientific journals and Medline database web pages of prime interest to pediatric surgeons have been developing at an amazing pace. Future developments of technological advance nurturing our specialty will consist of online journals, telemedicine, international chatting, computer-based training for surgical education, and centralization of cyberspace information into database search sites.

Child↗
PubMed2005

Improving animal research with an institutional electronic discussion group.

To remain at the forefront of scientific discovery, investigators continually are challenged to apply new approaches, instruments, and models to their work. Research institutions work to foster the exchange of ideas and resources, but this objective becomes more difficult to meet as the organization's size and complexity increase. To facilitate communication among researchers that use mice in their work and to provide increased opportunities for resource sharing, an electronic discussion group was formed at The Johns Hopkins University. The discussion group (jhu-mousers) is restricted to individuals within the institution's three campuses, and its 145 subscribers comprise faculty (including veterinarians), postdoctoral fellows, graduate students, and technicians. During its beginning 2 1/2-year period, jhu-mousers has received 207 postings that include seminar announcements; resource information; requests for mice, equipment, biological reagents, and technical assistance; and responses to these requests. The value of the electronic mailing list is evidenced by the fact that 70% of requests for resources or technical help have received at least one response, and this figure is likely to be underestimated because off-line responses are not included. Because the mailing list provides opportunities for tissue sharing and is conducive to refining experimental procedures used in mice, its application promotes the use of alternatives in animal research. To promote and assist the development of animal-user discussion groups at other institutions, the administration, applications, and benefits of an electronic mailing list for mouse users are discussed here.

Animal Experimentation↗
PubMed2005

Pediatric sedation in North American children's hospitals: a survey of anesthesia providers.

BACKGROUND: Information about the existence and organization of pediatric sedation services in North America is not available. We conducted a survey to collect this information from anesthesiologists at pediatric institutions and to identify factors perceived as limiting the development of sedation services. METHOD: We electronically mailed a confidential survey about pediatric sedation practice to an attending anesthesiologist involved in pediatric sedation at 116 children's hospitals in the United States and Canada. We identified the institutions using Internet resources. Electronic mailing addresses were obtained from departmental websites, society membership directories and departmental administrators. Our follow-up for nonresponders was by a second e-mail and a telephone call. RESULTS: A total of 54 completed questionnaires were received, a response rate of 47%. Forty-nine (91%) were received from US hospitals, and the remainder from Canadian. Fifty percent of hospitals had a formal pediatric sedation service. Fifty-four percent utilized a 'mobile' provider model. Hospital credentialing for nonanesthesiologist providers varied between 66 and 76% for 'deep' and 'conscious' sedation, respectively. A nurse-physician provider combination was the most common, utilized in 59% of hospitals. Anesthesiologists were the sole sedation providers in 26% of institutions. Propofol was used regularly by nonanesthesiologists for sedation of nonintubated (42%) and intubated (63%) patients. Eighty-seven percent of institutions reported barriers to development of pediatric sedation services. The most common barrier was a shortage of providers, particularly anesthesiologists. CONCLUSIONS: Propofol use by nonanesthesiologists is common. Addressing the shortage of providers, and allocating resources for credentialing providers will encourage further development of pediatric sedation practice.

Anesthesia↗
PubMed1998

Electronic communication and collaboration in a health care practice.

Using cognitive evaluation techniques, this study examines the effects of an electronic patient record and electronic mail on the interactions of health care providers. We find that the least structured communication methods are also the most heavily used: face-to-face, telephone, and electronic mail. Positive benefits of electronically-mediated interactions include improving communication, collaboration, and access to information to support decision-making. Negative factors include the potential for overloading clinicians with unwanted or unnecessary communications.

Communication↗
PubMed2001

Adoption of the AHCPR Clinical Practice Guideline for Smoking Cessation: a survey of California's HMOs.

OBJECTIVE: Our objective was to assess the degree to which health maintenance organizations (HMOs) and Medicaid managed care (MMC) plans in California have adopted the 1996 AHCPR Clinical Practice Guideline for Smoking Cessation. (AHCPR [U.S. Agency for Health Care Policy and Research] was renamed AHRQ [Agency for Healthcare Research and Quality] in 1999.) METHODS: A fax survey of 13 licensed HMOs and 21 MMC plans operating in California in 1999 with up to 10 follow-up contacts by telephone, mail, fax, and/or electronic mail. RESULTS: Awareness of the AHCPR guideline is widespread, and all HMOs in California in 1999 offered coverage for at least one treatment for smoking cessation. We found that 77% of the HMOs in California were aware of the AHCPR guideline, but less than half had used it to design benefits or distribute treatment guidelines to medical care providers in their networks. While only 23% of California HMOs covered the nicotine patch or gum, 69% covered at least one form of the pharmacotherapy and one type of counseling to treat tobacco dependence. In addition, a majority of the HMOs and MMC plans inform their members about coverage for smoking cessation treatments and inform providers about their role in helping smokers to quit. CONCLUSION: Considerable progress has been made in increasing access to effective smoking cessation treatments in California's managed care organizations over the last 10 years. Future efforts and research must concentrate on: (1) adopting the 2000 Public Health Service Clinical Practice Guideline on Treating Tobacco Use and Dependence, (2) increasing purchaser demand for coverage of tobacco dependence treatments, (3) increasing health plan documentation and monitoring of member smoking status, and (4) increasing provider provision of effective tobacco dependence treatments.

California↗
PubMed2001

Attitudes of maternal-fetal specialists concerning maternal-fetal surgery.

OBJECTIVE: We examined the attitudes of members of the Society for Maternal-Fetal Medicine regarding the clinical, scientific, ethical, and policy issues in maternal-fetal surgery. STUDY DESIGN: A 43-question survey was distributed to all members of the Society for Maternal-Fetal Medicine. Two mailings and one electronic mail reminder were sent, each with instructions to submit the survey either via US mail or the Internet. The survey included questions in six categories: physician demographic data, experience with maternal-fetal surgery, views on innovative therapies, scientific validation of currently used and proposed procedures, ethical issues, and future directions in public policy. RESULTS: Of the 1639 United States members sent questionnaires, 943 replied (response rate = 59%). Forty-seven percent had referred patients for open fetal surgery for nonlethal conditions, and 69% believed physicians were obligated to inform patients of this option. Seventy-eight percent believed that innovative therapies should be performed only under institutional review board-approved protocols. Although the majority of respondents believed that certain proposed benefits of open fetal surgery for myelomeningocele could offset the risks, the majority (56%) also indicated that the procedure has not been validated. Fifty-seven percent believed that a moratorium should be imposed on open fetal surgery for nonlethal conditions, such as myelomeningocele, until a multicenter-controlled clinical trial is completed. CONCLUSIONS: The use of maternal-fetal surgery for nonlethal conditions is highly controversial. The majority of maternal-fetal specialists we surveyed support further research before such procedures are integrated into clinical practice.

Adult↗
PubMed1999

[Pediatric research in an office-setting network--a new dimension in pediatric research in Israel].

Pediatric care in the community is gradually replacing traditional care in hospitals. Despite that, research activity in the community setting is minimal due to objective difficulties. These are mainly constraints of time, office work and lack of research-supporting logistics. In the past decade, throughout the world, primary physicians interested in research have grouped together and formed research networks. The aim of such networks is to support and promote research in the community. An Israel Pediatric Research in Office-Setting network (IPROS) was established 2 years ago by the Israel Ambulatory Pediatric Association (IAPA). Today, there are over 140 pediatricians listed in IPROS, representing the heterogeneous composition of pediatricians in Israel. The network's policy is defined by a joint steering committee. The committee is composed of IAPA representatives, senior network members and Schneider Hospital senior investigators. The research subjects are diverse, and represent common practical issues. Effective intra-net communication is vital to the existence of the network, and is accomplished by 3 modalities: 1) semiannual updates by mail, 2) e-mail, using an electronic mailing list to facilitate connection between members, 3) semi-annual meetings. Research budgets are derived from public sources like the Ministry of Health and IAPA, and private sources such as pharmaceutical companies. The administration of the network is supported by Schneider Children's Medical Center, and financed by IAPA.

Ambulatory Care↗