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PubMed1993

Product overview hotlist. Integration tools. Part 1.

November's HotList features integration tools. Due to the number of vendor offerings in this area, the second half of the Integration Tools HotList will appear in our December issue. All data have been provided by individual vendors who responded to survey questions. Computers in Healthcare has made an effort to contact all vendors within this market. See the 1993 Computers in Healthcare Market Directory for complete listings.

Catalogs, Commercial as Topic↗
PubMed1994

HotList. Case-management tools.

March's HotList features information systems designed to assist case managers. All data have been provided by individual vendors who responded to survey questions. Health Management Technology has made an effort to contact all vendors within this market. Of 213 vendors contacted, 26 responded as offering case-management-tool products. A full contact list may be requested by contacting HMT Editorial at (303) 220-0600. See the 1994 Health Management Technology Market Directory for complete listings.

Catalogs, Commercial as Topic↗
PubMed1994

HotList. Integration tools.

July's HotList features integration tools. Although many information systems vendors build custom interfaces or provide links to integrated systems, the focus of this Integration Tools HotList is to discover those companies who deliver truly useful tools for integrating disparate systems. All data provided by individual vendors responding to survey questions. Health Management Technology made every effort to contact all vendors within this market. Of 50 vendors contacted, 28 responded as offering integration tools. A full contact list may be requested by calling HMT editorial at (303) 220-0600. See The 1994 Health Management Technology Market Directory for complete listings.

Catalogs, Commercial as Topic↗
PubMed1994

HotList. Outcomes effectiveness measurement.

October's HotList features Outcomes Effectiveness Measurement products. All data have been provided by individual vendors responding to survey questions. Health Management Technology has made every effort to contact all vendors within this market. Of 80 vendors contacted, 31 responded as offering outcomes effectiveness measurement products. A full contact list may be requested by calling HMT editorial at (303) 220-0600. See The 1994 Health Management Technology Market Directory for complete listings.

Catalogs, Commercial as Topic↗
PubMed1999

Session management for web-based healthcare applications.

In health care systems, users may access multiple applications during one session of interaction with the system. However, users must sign on to each application individually, and it is difficult to maintain a common context among these applications. We are developing a session management system for web-based applications using LDAP directory service, which will allow single sign-on to multiple web-based applications, and maintain a common context among those applications for the user. This paper discusses the motivations for building this system, the system architecture, and the challenges of our approach, such as the session objects management for the user, and session security.

Computer Security↗
PubMedDate not supplied

How to find Chinese research participants: use of a phonologically based surname search method.

The frequent use of non-representative, time-consuming and low hit rate sampling methods in the study of minority cultures is of concern. Given the increasing cultural diversity of the Canadian population and the growing Chinese population, a sampling method using phonological rules to distinguish Chinese surnames from non-Chinese ones was developed. Chinese surnames, transcribed according to their pronunciations, follow specific phonological rules. A flowchart was developed using the inclusion and exclusion criteria derived from these rules. Methods to validate Chinese surnames (identified from telephone directory) were external reference source, expert panel, and telephone interview. A total of 266 possible Chinese surnames were selected using the flowchart. External reference source validated 153 surnames, expert panel 53, and telephone interview 23. An overall hit rate of 86.1% (229/266) was achieved, reflecting the validity of the phonological criteria in identifying individuals with a Chinese surname from the general population.

China↗
PubMedDate not supplied

How should we select health professionals for studies?

The investigation of healthcare professionals' practice patterns has increased sharply, in part driven by the development of practice guidelines; however, the optimal way to select providers is not known. We evaluated three distinct sources of physician specialists for completeness and potential biases. Professional society directories, which are frequently used to identify providers, provided biased populations. A national registry, the American Medical Association master file, produced the most comprehensive, least-biased single source.

American Medical Association↗
PubMedDate not supplied

The role of data-driven planning and coalition development in preventing cardiovascular disease.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States. Effective programs for the prevention and control of CVD need to include data-based planning and evaluation at the State and local levels. The authors describe the development of data-driven planning and intervention strategies in Missouri. Statewide planning activities have resulted in the formation of an advisory committee and development of a State plan, a resource directory, and training courses. Analysis of mortality data revealed an unusual concentration of CVD deaths in the southeast portion of the State. Local coalitions are being developed in each of six counties in this region to reduce the prevalence of CVD risk factors. A regional behavioral risk factor survey of 1,006 adults identified key risk factors that will be addressed by the coalitions. These data suggested that physical inactivity, obesity, and hypertension are especially acute problems in the area. Key components of the local coalition development included providing localized data and obtaining the strong commitment of the local health departments. Expanded use of chronic disease surveillance data for planning and evaluation will increase the probability that localities, States, and the nation will achieve Year 2000 Health Objectives. The data-based planning process is described as a possible model for use by other States and localities.

Cardiovascular Diseases↗
PubMed1994

Building a Database of Data Sets for Health Services Research.

The Database of Data Sets (DB/DS) for Health Services Research will be an online searchable directory of data sets which are available, often with restrictions and confidentiality safeguards, for use by health care researchers. The DB/DS project is aimed at a wide audience, and intends to include a very broad range of health care data sets, ranging from state hospital discharge data bases, to national registries and health survey data sets, to institutional clinical databases. The intended users are the same community of researchers, policy-makers, administrators and practitioners who are served by the National Library of Medicine's current bibliographic databases. This paper describes a pilot phase of the DB/DS project in which the issues involved in creating such a database were explored with an initial set of 20 representative data sets.

Databases, Factual↗
PubMed1994

Social services to assist nutrition.

Social services to assist in improving nutritional status in older adults are reviewed. The social service interventions are placed in three broad categories of risk for older people to include poverty, social isolation, and dependency/disability. Each social service is identified and described to include eligibility and local resources. A social services intervention contact guide is provided as well as a state-by-stage aging services and resources directory.

Aged↗
PubMed2002

Product-related emphasis of skin disease information online.

BACKGROUND: In 2000, 41 million people searched for medical information online. The quality of that information is unregulated, variable, and not well studied. OBJECTIVE: To quantify and compare the numbers and types of Internet sites matched for 10 diverse skin conditions through different search systems. DESIGN: Search strategies were performed at 6-month intervals via Netscape Navigator, using 3 search engines and 1 directory. Ten skin conditions were chosen to represent common (psoriasis and eczema), cosmetic (wrinkles and cellulite), difficult-to-treat (alopecia, mastocytosis, granuloma annulare, and xanthoma), and uncommon (dermatitis herpetiformis and epidermolysis bullosa) problems. Search strings were designed to generate lists of Web sites that provide educational or product-related information. Results were compared. SETTING: The Saint Louis University information technology server, July 9, 1999, December 16, 1999, and February 5, 2000. MAIN OUTCOME MEASURES: Comparisons of the total number, top 10 ranking, and type (educational vs product-related) of sites that matched through different search systems at 6-month intervals. RESULTS: The total number of matched sites for different skin conditions varied up to 100-fold. This number increased by 30% to 316% between July and December 1999. The largest number of Web sites related to wrinkles, followed by Web sites related to common conditions. Product-related sites outnumbered educational sites, especially for common and cosmetic conditions. Although there were differences in the total number of sites found through different search engines, the ratios of product-related to educational sites were similar. Different search engines yielded different top 10 match lists for the same condition. The top 10 lists included higher proportions of educational sites than the total match lists for all conditions except cellulite. Within the top 10 lists, the rank order of well respected sites varied by search engine used and changed over time. CONCLUSIONS: Patients are increasingly accessing the growing body of data available through the Internet. Most Web sites contain information related to products. Until standards are enacted to govern the distribution of online medical information, consumers are at risk for obtaining misinformation and buying ineffective products. To better guide patients, physicians must become familiar with this ever-changing information.

Female↗
PubMed2005

Variation in the diagnosis, treatment, and management of melanoma in situ: a survey of US dermatologists.

OBJECTIVE: To assess current practices of US dermatologists regarding the diagnosis, treatment, and management of melanoma in situ (MIS). DESIGN: Survey. PARTICIPANTS: A total of 1200 dermatologists randomly selected from the American Board of Medical Specialists Directory of Board Certified Medical Specialists. MAIN OUTCOME MEASURES: Results based on 597 questionnaires returned. RESULTS: The overall response rate was 63% (597 of 945 eligible participants). To aid in clinical assessment, respondents reported using a magnifying lens (57.4%) and dermoscopy (17.4%). Most dermatologists preferred excisional and saucerization biopsies as the method of choice for sampling. A large percentage of physicians (78.9%) preferentially used dermatopathologists for the evaluation of the majority of pigmented lesions. Although most respondents would not unquestioningly accept a benign pathology diagnosis when there was a clinical suspicion of MIS, 16.1% would accept a pathologist's diagnosis without further action. There was no consensus on the appropriate surgical margins or depth of excision for MIS. Of the respondents who characterized MIS as premalignant and malignant, 63.2% and 46.4%, respectively, did not know what percentage of MISs would progress to metastatic disease if left untreated. CONCLUSIONS: Considerable variability exists in the clinical concept and management of MIS. Dermoscopy is underutilized. The true nature of the evolution of MIS is unknown. Surgical margins and depth of excision need to be standardized to help dermatologists manage disease. Further research in the specific area of MIS is warranted to develop clear guidelines in the management and prevention of further disease.

Biopsy, Needle↗
PubMed1994

Psychosocial interest, medical interviews, and the recognition of depression.

OBJECTIVES: To measure primary care physicians' attitudes toward psychosocial issues, determine their relationship to the style of the medical interview, and assess whether attitudes and interview behaviors lead to correct diagnosis in patients with depression. DESIGN: Physicians were videotaped while interviewing four patients standardized with criteria symptoms of major depression. Physicians were unaware of the mental health focus of the study. SETTING: Patient examining rooms. PARTICIPANTS: Physicians were eligible for recruitment if they were board certified or eligible in family practice or internal medicine, practiced primary care medicine, and were listed in regional directories. Standardized patients were recruited from the community. MAIN OUTCOME MEASURES: Attitudes toward psychosocial issues (measured by the Physician Belief Scale), interview content (measured by review of the videotaped encounters), interview behaviors (measured by the Interaction Analysis System for Interview Evaluation), and a listing of depression in the differential diagnosis (determined by physician debriefing interviews). RESULTS: Forty-seven community-based practitioners participated. Forty-eight percent of interviews resulted in a diagnosis of depression. Physician Belief Scale scores were not significantly correlated with patient-centered interviewing, psychosocial questions, inquiry about depression symptoms, or a depression diagnosis. Longer interviews were more likely to result in a depression diagnosis. CONCLUSIONS: High interest in psychosocial issues was not associated with patient-centered interviewing behaviors, questions about psychosocial or depression symptoms, or depression diagnoses. However, certain patient-centered interviewing behaviors, particularly those defined as "affective," did lead to the recognition of depression.

Adult↗
PubMedDate not supplied

A survey of skin cancer screening in the primary care setting: a comparison with other cancer screenings.

OBJECTIVE: To determine primary care physicians' perceived importance and frequency of performance of skin cancer screening in comparison with other cancer screening examinations. DESIGN: Descriptive survey study. PARTICIPANTS: Five thousand US family physicians and internal medicine specialists randomly selected from the Official American Board of Medical Specialists Directory of Board-Certified Medical Specialists. MAIN OUTCOME MEASURES: Self-reported importance and performance of cancer screening examinations. RESULTS: Eligible physicians (1363 total: 814 family physicians and 549 internists) completed the survey with a response rate of 30%. Overall, 52% of respondents rated skin cancer screening as "extremely" important, compared with 79% for digital rectal examination, 88% for clinical breast examination, and 87% for Papanicolaou testing. Thirty-seven percent of physicians reported performing complete body skin examinations on 81% to 100% of patients, compared with digital rectal examination, for which 78% of physicians reported performing the examination on 81% to 100% of patients, or the clinical breast examination, for which 82% of physicians reported performing the examination on 81% to 100% of patients. A higher percentage of physicians in practice for more than 30 years ranked skin cancer screening as extremely important and reported a higher frequency of screening examinations. Physicians in a suburban practice setting reported performing skin examinations more often than those in urban or rural settings. Overall, the self-reported frequency of skin examination was strongly correlated with the physician's importance rating of skin cancer screening. CONCLUSIONS: A majority of primary care physicians rate skin cancer screening as extremely important. The reported importance of skin cancer screening and frequency of skin cancer examination among primary care physicians is significantly less than for other cancer examinations. This likely represents a multitude of factors, including logistic constraints and lack of consensus on the efficacy of skin cancer screening. Arch Fam Med. 2000;9:1022-1027

Breast Neoplasms↗
PubMed2005

Ties that bind: multiple relationships between clinical researchers and the pharmaceutical industry.

BACKGROUND: It is believed that pharmaceutical industry sponsorship of clinical research leads to the development of multiple ties between clinicians and the pharmaceutical industry. To quantify this relationship we conducted a survey of medical specialists listed in the Medical Directory of Australia in 2002 and 2003. METHODS: A questionnaire was mailed that elicited information about all aspects of research relationships between clinicians and pharmaceutical companies. The odds of reporting multiple additional ties (financial and professional) with pharmaceutical companies by clinicians who had an active research relationship were compared with those who did not. All clinicians who returned a completed questionnaire about their research activities were included in the study. RESULTS: A questionnaire was mailed to 2120 medical specialists; 823 (39%) responded. Of these, 338 (41%) reported involvement in industry-sponsored research in the previous year. They were more likely than others to have been offered industry-sponsored items or activities valued at more than 500 AU dollars (>382 US dollars; odds ratio [OR], 3.5; 95% confidence interval [CI], 2.6-4.7) and support for attending international conferences (OR, 5.4; 95% CI, 3.9-7.4). The strongest associations were seen for acting as a paid consultant to industry (OR, 9.0; 95% CI, 3.9-20.4) and for membership on advisory boards (OR, 6.9; 95% CI, 5.1-9.6). There was a strong relationship between research collaboration and accumulation of industry ties. For 1 additional tie the OR was 2.2 (95% CI, 1.2-3.8) and rose to 6.3 (95% CI, 3.5-11.1) with 3 ties and 41.8 (95% CI, 14.5-143.4) with 6 or more ties. CONCLUSIONS: Medical specialists who have research relationships with the pharmaceutical industry are much more likely to have multiple additional ties than those who do not have research relationships. Institutional review should discourage clinical researchers from developing multiple ties.

Australia↗
PubMed2001

Use of rigid and flexible bronchoscopy among pediatric otolaryngologists.

OBJECTIVE: To explore how rigid and flexible bronchoscopy are used in pediatric otolaryngologic practice. DESIGN: Survey. PARTICIPANTS: Members of the American Society of Pediatric Otolaryngology who practice in the United States and Canada and were listed in the membership directory were eligible. Of the 206 members, 24 practicing outside the United States or Canada and 11 without an e-mail address or a fax machine were excluded. Hence, a questionnaire was e-mailed or faxed to 171 pediatric otolaryngologists. MAIN OUTCOME MEASURES: Questions concerned the practice setting, type and number of bronchoscopies, indications, complications, and medicolegal cases. RESULTS: Responses were received from 120 subjects (70.2%), with 3 retired and 2 practicing only otology, leaving 115 respondents who completed at least some of the questionnaire. Rigid and flexible bronchoscopy were performed by 72.7% (56/77) of those in academic settings and by 71.1% (27/38) of those in group or solo practices. In the last 12 months, approximately 10 454 total bronchoscopies were performed, with 2052 flexible and 9117 rigid bronchoscopies. Stridor, suspected foreign body inhalation, and laryngomalacia were the most common indications for bronchoscopy. Of the 83 respondents practicing rigid and flexible bronchoscopy, 25 (30.1%) used both instruments to manage complex or repeated foreign bodies, 25 (30.1%) used both to manage patients with cystic fibrosis, and 15 (18.1%) used both to manage simple foreign bodies. Complications were reported by 15.7% of the respondents, the most common being arrhythmia. Familiarity with a case resulting in medicolegal action was reported by 32.2% of the respondents. CONCLUSIONS: Rigid and flexible bronchoscopy have multiple uses in pediatric otolaryngologic practice. Also, flexible bronchoscopy appears to be emerging as a more frequently used diagnostic and therapeutic tool.

Bronchoscopes↗