Sophisticated hospital information system/radiology information system/picture archiving and communications system (PACS) integration in a large-scale traumatology PACS.
Picture archiving and communications system (PACS) in the context of an outpatient trauma care center asks for a high level of interaction between information systems to guarantee rapid image acquisition and distribution to the surgeon. During installation of the Innsbruck PACS, special aspects of traumatology had to be realized, such as imaging of unconscious patients without identification, and transferred to the electronic environment. Even with up-to-date PACS hardware and software, special solutions had to be developed in-house to tailor the PACS/hospital information system (HIS)/radiology information system (RIS) interface to the needs of radiologic and clinical users. An ongoing workflow evaluation is needed to realize the needs of radiologists and clinicians. These needs have to be realized within a commercially available PACS, whereby full integration of information systems may sometimes only be achieved by special in-house solutions. (+info)
The dissemination of clinical practice guidelines over an intranet: an evaluation.
This study compares two clinical practice guideline dissemination systems. It was hypothesized that placing guidelines on an intranet would make this information easier to retrieve. Retrieval time, retrieval accuracy, and ease of use were empirically evaluated. Sixteen clinicians from Kaiser Permanente volunteered to complete tasks that measured these variables. Time values were significantly longer for tasks completed with intranet guidelines (Intranet = 6.7 minutes, Paper = 5.7 minutes). Tasks completed with paper guidelines had a significantly higher percentage of perfect scores than those completed with the intranet (Paper = 85%, Intranet = 59%). There was no significant difference in reported ease of use. Simply placing clinical information on an electronic system does not guarantee that the information will be easier to retrieve. Such information needs to be fully integrated into the clinical decision making process. Computerizing guidelines may provide a necessary initial step toward this goal, but it does not represent the final solution. (+info)
Analysis of information needs of users of the Stanford Health Information Network for Education.
OBJECTIVE: To examine the information needs of users of the Stanford Health Information Network for Education (SHINE), an integrated information retrieval (IR) system. METHODS: A subset of queries from the SHINE log were categorized into one or more of 33 categories. RESULTS: Drugs and infectious disease accounted for 25% of categorizations, and otherwise the distribution of categorizations was quite broad. CONCLUSIONS: Attention should be paid to the selection of drug information resources in medical knowledge information retrieval systems. The distribution of query categorizations also suggests that IR systems include a wide range of knowledge resources. (+info)
Management confidence and decisions to refer to hospital of GP registrars and their trainers working out-of-hours.
BACKGROUND: There is concern about the educational impact and possible stress on registrars of new out-of-hours co-operatives. AIM: To compare the confidence in managing out-of-hours problems of registrars in traditional on-call rotas and co-operatives with that of their trainers. To determine how frequently registrars discussed problems out-of-hours with their trainers, and to compare the referral pattern of registrars with their trainers out-of-hours. METHOD: Analysis of log diaries of out-of-hours experiences kept by registrars and trainers over two, two-month periods in winter and summer. RESULTS: Thirty registrars (out of a possible 51) and 34 (out of a possible 52) trainers took part in the winter, and 18 registrars and 29 trainers in the summer. Registrars were confident in their management, and their confidence increased over the year (59% versus 72% difference = 12%, 95% CI = 6% to 20% for very confident). Registrars varied in their discussion of problems with trainers. When 'a little worried' they discussed their management 30 out of 53 times (57%); if 'very confident', 36 out of 576 times (6%). Registrars during the summer segment of the study referred more frequently to hospital than trainers (20% versus 10% difference = 10%, 95% CI = 3% to 17%. Registrars in traditional rotas recorded a slightly higher but statistically insignificant level of confidence in their management of problems than those registrars in cooperatives. CONCLUSIONS: While many registrars are confident in their work and are using their trainer for information appropriately, some are not. Registrars may be referring to hospital at a much higher rate than their trainers. More research is required to confirm and further explore these findings. (+info)
Doctors on tribunals. A confusion of roles.
BACKGROUND: Mental health review tribunals are required to apply legal criteria within a clinical context. This can create tensions within both law and psychiatry. AIMS: To examine the role of the medical member of the tribunal as a possible mediator between the two disciplines. METHOD: Observation of tribunal hearings and panel deliberations and interviews with tribunal members were used to describe the role of the medical member. RESULTS: The dual roles imposed on the medical member as witness and decision-maker and as doctor and legal actor create formal demands and ethical conflicts that are hard, in practice, either to meet or to resolve. CONCLUSIONS: The structure for providing tribunals with access to expert psychiatric input and advice requires reconsideration. (+info)
Why are antibiotics prescribed for asymptomatic bacteriuria in institutionalized elderly people? A qualitative study of physicians' and nurses' perceptions.
BACKGROUND: Antibiotic therapy for asymptomatic bacteriuria in institutionalized elderly people has not been shown to be of benefit and may in fact be harmful; however, antibiotics are still frequently used to treat asymptomatic bacteriuria in this population. The aim of this study was to explore the perceptions, attitudes and opinions of physicians and nurses involved in the process of prescribing antibiotics for asymptomatic bacteriuria in institutionalized elderly people. METHODS: Focus groups were conducted among physicians and nurses who provide care to residents of long-term care facilities in Hamilton, Ont. A total of 22 physicians and 16 nurses participated. The focus group discussions were tape-recorded, and the transcripts of each session were analysed for issues and themes emerging from the text. Content analysis using an open analytic approach was used to explore and understand the experience of the focus group participants. The data from the text were then coded according to the relevant and emergent themes and issues. RESULTS: We observed that the ordering of urine cultures and the prescribing of antibiotics for residents with asymptomatic bacteriuria were influenced by a wide range of nonspecific symptoms or signs in residents. The physicians felt that the presence of these signs justified a decision to order antibiotics. Nurses played a central role in both the ordering of urine cultures and the decision to prescribe antibiotics through their awareness of changes in residents' status and communication of this to physicians. Education about asymptomatic bacteriuria was viewed as an important priority for both physicians and nurses. INTERPRETATION: The presence of non-urinary symptoms and signs is an important factor in the prescription of antibiotics for asymptomatic bacteriuria in institutionalized elderly people. However, no evidence exists to support this reason for antibiotic treatment. Health care providers at long-term care facilities need more education about antibiotic use and asymptomatic bacteriuria. (+info)
Exposure to sputum positive cases of tuberculosis in a government hospital.
A retrospective study was carried out to ascertain the degree of exposure to the tubercle bacillus within Ipoh Hospital. This study reveals that, over a one year period, 92 sputum positive cases were admitted to the general wards. In 11 of these cases, drug resistance was considered to be possible. The mean time from admission to the commencement of treatment was seven days for the newly diagnosed cases. This study thus documents a significant degree of in-hospital exposure to the tubercle bacillus. (+info)
Application of the alkaline comet assay in human biomonitoring for genotoxicity: a study on Croatian medical personnel handling antineoplastic drugs.
The alkaline comet assay was used to evaluate the genotoxicity towards peripheral blood lymphocytes of medical personnel regularly handling various antineoplastic drugs with different safety precautions. The study population consisted of 50 exposed subjects working in the oncology, pulmonology, gynaecology and haematology units of nine Croatian hospitals and 20 unexposed control subjects. Peripheral blood lymphocytes from the subjects were embedded in agarose on a microscope slide and lysed; the DNA was unwound and subjected to electrophoresis at pH 13. Staining with a fluorescent dye was used to identify cells with DNA damage, as judged by increased migration of genetic material from the cell nucleus. DNA damage was quantified by measuring the displacement between the genetic material of the nucleus and the resulting tail using an image analysis system. Three parameters were used as indicators of DNA damage: i.e. tail length, percentage of DNA in the tail and tail moment. Statistically significant differences in all three parameters were observed between the exposed and control groups. Within the exposed group, there were marked differences between individuals in the comet tail parameters. In the majority of exposed subjects an effect on DNA damage of age or duration of occupational exposure could be excluded. In the exposed group, the highest level of DNA damage was recorded in subjects who used only latex gloves in their work with antineoplastic drugs. The observed DNA damage was lower in exposed subjects who used more than one type of protective equipment and who worked in a well-ventilated safety cabinet. No statistically significant differences were found between the mean values of comet tail parameters for smoking and non-smoking subpopulations from the exposed group. In view of the results obtained, the alkaline comet assay, as a simple, rapid and sensitive method, appears to be a promising additional test for biomonitoring purposes in human populations. (+info)