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PubMed2006

Psychoeducation: a basic psychotherapeutic intervention for patients with schizophrenia and their families.

Psychoeducation was originally conceived as a composite of numerous therapeutic elements within a complex family therapy intervention. Patients and their relatives were, by means of preliminary briefing concerning the illness, supposed to develop a fundamental understanding of the therapy and further be convinced to commit to more long-term involvement. Since the mid 1980s, psychoeducation in German-speaking countries has evolved into an independent therapeutic program with a focus on the didactically skillful communication of key information within the framework of a cognitive-behavioral approach. Through this, patients and their relatives should be empowered to understand and accept the illness and cope with it in a successful manner. Achievement of this basic-level competency is considered to constitute an "obligatory-exercise" program upon which additional "voluntary-exercise" programs such as individual behavioral therapy, self-assertiveness training, problem-solving training, communication training, and further family therapy interventions can be built. Psychoeducation looks to combine the factor of empowerment of the affected with scientifically founded treatment expertise in as efficient a manner as possible. A randomized multicenter study based in Munich showed that within a 2-year period such a program was related to a significant reduction in rehospitalization rates from 58% to 41% and also a shortening of intermittent days spent in hospital from 78 to 39 days. Psychoeducation, in the form of an obligatory-exercise program, should be made available to all patients suffering from a schizophrenic disorder and their families.

Cognition↗
PubMed2004

Development and implementation of a database system to manage a large-scale mouse ENU-mutagenesis program.

A mouse ENU-mutagenesis program at RIKEN GSC has been initiated to conduct a large-scale, genome-wide, early- and late-onset phenotypic screen of mutant mice. We screened about a hundred mice every week with a comprehensive set of phenotype assays including behavioral tests based on a modified SHIRPA protocol, blood tests (both clinical biochemical testing and hemogram), and measurement of locomotor activity in their home cages. To manage the entire program, we developed a client/server architecture database system and named it MUSDB (Mutagenesis Universal Support DataBase). It manages mouse husbandry, mating protocols, procedures for ENU injection and phenotypic screens, phenotype inheritance tests, preservation of sperm and organs, and other materials generated during the program. We have implemented MUSDB in quite a large-scale system that includes 150 client computers. It has, helped reduce typographical errors and provided simple and efficient operation via its front-end user interface. It significantly contributed to the communication within and between workgroups in the program and in the accumulation of various phenotypic and inheritance data.

Animals↗
PubMed2001

What Digital Imaging and Communication in Medicine (DICOM) could look like in common object request broker (CORBA) and extensible markup language (XML).

Common object request broker architecture (CORBA) is a method for invoking distributed objects across a network. There has been some activity in applying this software technology to Digital Imaging and Communications in Medicine (DICOM), but no documented demonstration of how this would actually work. We report a CORBA demonstration that is functionally equivalent and in some ways superior to the DICOM communication protocol. In addition, in and outside of medicine, there is great interest in the use of extensible markup language (XML) to provide interoperation between databases. An example implementation of the DICOM data structure in XML will also be demonstrated. Using Visibroker ORB from Inprise (Scotts Valley, CA), a test bed was developed to simulate the principle DICOM operations: store, query, and retrieve (SQR). SQR is the most common interaction between a modality device application entity (AE) such as a computed tomography (CT) scanner, and a storage component, as well as between a storage component and a workstation. The storage of a CT study by invoking one of several storage objects residing on a network was simulated and demonstrated. In addition, XML database descriptors were used to facilitate the transfer of DICOM header information between independent databases. CORBA is demonstrated to have great potential for the next version of DICOM. It can provide redundant protection against single points of failure. XML appears to be an excellent method of providing interaction between separate databases managing the DICOM information object model, and may therefore eliminate the common use of proprietary client-server databases in commercial implementations of picture archiving and communication systems (PACS).

Computer Communication Networks↗
PubMed2000

[Intranet applications in radiology].

UNLABELLED: The aim of the paper is to present the conceptual basis and capabilities of intranet applications in radiology. The intranet, which is the local brother of the internet can be readily realized using existing computer components and a network. All current computer operating systems support intranet applications which allow hard and software independent communication of text, images, video and sound with the use of browser software without dedicated programs on the individual personal computers. Radiological applications for text communication e.g. department specific bulletin boards and access to examination protocols; use of image communication for viewing and limited processing and documentation of radiological images can be achieved on decentralized PCs as well as speech communication for dictation, distribution of dictation and speech recognition. DISCUSSION: The intranet helps to optimize the organizational efficiency and cost effectiveness in the daily work of radiological departments in outpatients and hospital settings. The general interest in internet and intranet technology will guarantee its continuous development.

Computer Communication Networks↗
PubMed2006

Perceptions of prescribed burning in a local forest community in Victoria, Australia.

The general perceptions of prescribed burning were elicited from forest users for an area that has been subject to this form of land management for at least 20 years. The largest group consisted of local residents living in and around the Wombat State Forest with two smaller groups of students from a nearby university campus and local professional land managers. A questionnaire was given to each participant in order to explore how the forest was used, to determine the level of knowledge of burning in the targeted forest and Victoria and the perception of the appearance, effectiveness of protection, and accessibility to the forest after prescribed burning. Generally all groups had similar responses with community members having stronger views on the effectiveness and practicalities of prescribed burning, whereas students were more neutral in their opinions. All participants claimed knowledge of prescribed burning activities within Victoria, but fewer had experience of planned fires in the Wombat State Forest. All groups agreed that areas that had not been recently burned had a better appearance than those that had, but this result may have included a range of value judgments. Land managers had a greater understanding of the ecological importance of season and timing of burning; however, some students and community members were equally knowledgeable. Prescribed burning did not impede access to the forest, nor did smoke from prescribed burns pose any great problem. The majority of the participants felt that the amount of prescribed burning done in the forest was adequate for engendering a feeling of protection to life and property, yet many were still suspicious of this management practice. These initial findings indicate several areas in which further research would be useful including the efficacy of education programs for community members and improved communication of burn plans by land managers.

Conservation of Natural Resources↗
PubMed2006

Integrating social science and design inquiry through interdisciplinary design charrettes: an approach to participatory community problem solving.

Interdisciplinary collaborations that aim to facilitate meaningful community outcomes require both the right mix of disciplinary knowledge and effective community participation, which together can deepen collective knowledge and the capacity to take action. This article explores three interdisciplinary design charrettes, intensive participatory workshops that addressed specific community problems and provided a context for integrating design and social science inquiry with local community knowledge. Evaluation data from the charrettes shed light on how students from the design and social science disciplines experienced the charrettes, and on their interactions with community members. Key advantages to this interdisciplinary, community-based collaboration included expanded knowledge derived from the use of multiple modes of inquiry, particularly the resulting visualization tools that helped community members understand local issues and envision novel solutions. Key drawbacks included difficulties in balancing the two disciplines, the tendency for social scientists to feel out of place on designers' turf, and the increased disciplinary and interpersonal conflicts arising from a more diverse pool of participants.

Community Health Planning↗
PubMed2006

The making of an interdisciplinary partnership: the case of the Chicago Food System Collaborative.

Interdisciplinary partnerships foster innovation to address pressing social problems. This paper describes an interdisciplinary partnership called the Chicago Food System Collaborative (CFSC) composed of a team of partners from four academic institutions and three community-based organizations representing a total of eight disciplines that included: community development and community organizing, community psychology, geography, nursing, nutrition, public health, sociology, and urban planning and policy. Partners came together to address the issue of access to healthy foods and nutrition in a working class African American neighborhood. We analyze and discuss the core principles that guided the partnership and its impact across three dimensions: understanding through interdisciplinary action research, building capacity, and facilitating innovations in practices and policies. Despite the challenges of interdisciplinary partnerships, the potential benefits and impact of such efforts reflect their value as a comprehensive approach to addressing complex social problems.

Black or African American↗
PubMed2006

Increasing access to program information: a strategy for improving adolescent health.

OBJECTIVES: To identify existing programs serving 11- to 15-year-olds that aim to improve adolescent health in the areas of Health & Well-being, Fitness, Family & Peer Relationships, School Environment, Smoking, Alcohol Use, and Violence and to assess the utility of readily available resources in providing detailed program information. METHODS: In Phase 1, publicly available program databases were searched to identify potential programs serving the target population. In Phase 2, an in-depth search of a limited sample of programs meeting the content and age criteria was performed to identify program descriptors. RESULTS: Over 1,000 program names were identified in Phase 1. Information regarding programs is becoming more readily available through the internet; however, the program information that was publicly available only begins to draw the picture. Phase 2 revealed that a broad array of efforts are underway in all seven content areas, but found information on the program descriptors to be limited. CONCLUSIONS: Investment in programming is not enough; an upfront investment in communication and information sharing is critical in order to maximize the resources dedicated to the improvement of adolescent health. A well-publicized centralized program repository offered in conjunction with technical assistance would provide an efficient mechanism for this information sharing. We further suggest that the inherent gap between research and practice can be lessened by building a new body of practice knowledge. This would require improved program data collection by programs, the incorporation of program participation information in national surveys and enhanced evaluation efforts.

Adolescent↗
PubMed1980

Problems and approaches in the surveillance and control of sexually transmitted diseases: the Cuban experience.

Cuba has a comprehensive National Health System which delivers primary and secondary health care to 100% of the population. Communicable disease control and preventive medicine programs are implemented through this System. The National Syphilis Control Program is described briefly as an example of a successful control program for sexually transmitted disease. Data defining the magnitude of the problems of gonorrhea and pelvic inflammatory disease are not complete. A program for improved gonorrhea surveillance and control is just beginning. Further improvements and refinements in this program are described.

Cuba↗
PubMed1996

Evolution of battery-powdered, vented left ventricular assist devices.

Battery-powered, vented left ventricular assist devices are designed to provide long-term circulatory support and an enhanced qualify of life. Their ongoing evolution into an effective clinical tool to treat patients with severe heart failure has resulted from the efforts of many, the open communication among researchers involved in the program, and the strong support from the National Institutes of Health.

Equipment Design↗
PubMed2006

A service based approach for medical image distribution in healthcare Intranets.

The Digital Imaging and Communications in Medicine (DICOM) protocol is currently the ubiquitous standard for the communication of medical images and related data within the radiology department. However, seamless image distribution within the healthcare enterprise and especially with research and educational information systems is still hard to achieve, as software developers of such third-party applications have to go through the rather cumbersome task of adapting the DICOM communication model and implementing the DICOM protocol. This paper gives a brief outline of current trends in medical image distribution in the healthcare enterprise, and proposes a new technological approach for distributing DICOM images and related data through commonplace Internet technologies, based on the emerging web services software paradigm. In particular, the paper describes the DICOM Image Management (DIM) web service which acts as a façade for conventional DICOM sources allowing DICOM image data and related information, to be transformed into XML documents encapsulated in SOAP messages, enabling integration at the application level through general purpose standardized web technologies. Implementation issues are discussed and a demonstration of engaging the DIM web service is included.

Computer Communication Networks↗
PubMed2006

The impact of the implementation of a rehabilitation tool on the contents of the communication during multidisciplinary team conferences in rheumatology.

OBJECTIVE: Problems with multidisciplinary team conferences in health care include the exchange of too much (discipline-specific) information. The aim of this study was to investigate the effect of the implementation of a rehabilitation tool on the contents of communication during multidisciplinary team conferences in a rheumatology setting. METHODS: All initial and follow-up team conferences of 25 consecutive patients with rheumatoid arthritis admitted to a day patient care ward were videotaped during a period before (period I) and after (period II) the introduction of a rehabilitation tool. The aims of the rehabilitation tool were to enhance discussions on the co-ordination of care rather than merely exchange of information. This was achieved by providing a framework for the setting and evaluation of common treatment goals and management strategies as well as accompanying electronic and printed records. For every team conference, the duration of time spent on three types of communication was recorded: (1) grounding regarding the patient's health status, (2) the making of practical arrangements by no more than two health professionals, and (3) the co-ordination of common treatment goals or management strategies. Comparisons of the proportions of time spent on the different types of communication between the two periods were done by means of the Mann-Whitney U-test. RESULTS: Apart from the 25 initial team conferences in both periods, 86 and 71 follow-up team conferences were available in periods I and II, respectively. Regarding the initial team conferences, the proportion of time spent on grounding and practical arrangements was significantly smaller in period II than in period I. In addition, the proportion of time spent on common goals or management strategies was significantly greater in period II than in period I. For the follow-up team conferences, the proportion of time spent on practical arrangements was significantly smaller in period II, than in period I. Moreover, the proportions of time spent on the other types of communication did not differ significantly between the two periods. CONCLUSION: The implementation of a rehabilitation tool including a computer application increased the proportion of time spent on the discussion of common treatment goals or management strategies during initial but not during follow-up team conferences in a day patient rheumatology clinic.

Cohort Studies↗
PubMed2006

Victimization and health among indigent young women in the transition to adulthood: a portrait of need.

PURPOSE: To understand victimization by physical and sexual violence and its association with physical and behavioral health in a probability sample of sheltered homeless and low-income-housed young women in the transition to adulthood (ages 18 through 25). METHODS: Participants were 224 women ages 18 through 25 who were selected by means of a stratified random sample from 51 temporary shelter facilities (N = 94) and 66 Section 8 private project-based Housing and Urban Development (HUD)-subsidized apartment buildings (N = 130) in Los Angeles County, California. Women completed structured interviews. RESULTS: Forty-one percent of the sample had been physically or sexually victimized as children and 51% had been victimized since turning 18. Young women who experienced victimization were significantly (p < .05) more likely than non-victimized women to have a sexually-transmitted disease (STD) other than HIV/AIDS or Hepatitis B or C, vaginal discharge or bleeding and pelvic pain in the past 6 months, and past-12 month screening diagnoses of drug abuse/dependence and depression. Victimized women were also significantly more likely to use alcohol to intoxication and drugs, including crack and amphetamines, during the past 6 months, and to have experienced psychological distress and poor self-esteem. CONCLUSIONS: This study highlights striking rates of victimization and its association with physical and behavioral health problems among indigent young women during the period of emerging adulthood. This portrait of need communicates an urgency to develop multifaceted programs for such women to help them successfully navigate the transition to adulthood and realize their full potential as adults.

Adolescent↗
PubMed2005

What do other local providers think of NHS walk-in centres? Results of a postal survey.

OBJECTIVES: To ascertain the views of other providers of primary and emergency healthcare services about their local walk-in centre. DESIGN: Postal survey. SETTING AND PARTICIPANTS: National Health Service healthcare providers (general practitioners (GPs), practice nurses, pharmacists, Accident and Emergency (A and E) consultants) working in close proximity to 20 English walk-in centres. RESULTS: The overall response rate to the survey was 79% (n = 1591). Nearly one-third of respondents felt that patient expectations had increased since their local walk-in centre opened, although this varied across the different sites. Some providers had noticed a reduction in their workload, but 15% claimed that workloads had increased since their local walk-in centre opened. There was broad agreement that these new centres did address issues of access and that they provided appropriate care of a reasonable quality. Communication between walk-in centres and other local healthcare providers was an area of considerable concern; GPs, in particular, were anxious about the impact of the service on continuity of care. There were clear differences of opinion between different types of health professional, with doctors tending to be more critical and practice nurses being more supportive. CONCLUSION: It has been suggested that healthcare professionals, notably GPs, are universally opposed to the concept of walk-in centres. This survey shows that opinions were divided, but overall, more local providers were in favour of this new service than were opposed to it. There was more support for centres co-located with A and E departments than "shop-front"-type facilities, but there were concerns that the service offered was too limited. The success or otherwise of the walk-in centre initiative will depend, in part, on building good relationships between the centres and other local providers. Understanding the views of local providers is important for those developing walk-in centres, and for those engaged in planning services in the wider health economies where these services are placed.

Ambulatory Care Facilities↗