Clinical information systems end user satisfaction: The expectations and needs congruencies effects

Prior research on information systems (IS) shows that users’ attitudes and continuance intentions are associated with their satisfaction with information systems. As such, the increasing amount of investments in clinical information systems (CIS) signifies the importance of understanding CIS end users’ (i.e., clinicians) satisfaction. In this study, we develop a conceptual framework to identify the cognitive determinants of clinicians’ satisfaction formation. The disconfirmation paradigm serves as the core of the framework. The expectations and needs congruency models are the two models of this paradigm, and perceived performance is the basis of the comparisons in the models. The needs and expectations associated with the models are also specified. The survey methodology is adopted in this study to empirically validate the proposed research model. The survey is conducted at a public hospital and results in 112 and 203 valid responses (56% and 98% response rates) from doctors and nurses respectively. The partial least squares (PLS) method is used to analyze the data. The results of the study show that perceived CIS performance is the most influential factor on clinicians’ (i.e., doctors and nurses) satisfaction. Doctors’ expectations congruency is the next significant determinant of their satisfaction. Contrary to most previous findings, nurses’ expectations and expectations congruency do not show a significant effect on their satisfaction. However, the needs congruency is found to significantly affect nurses’ satisfaction.     

The Apex polyester fibre anterior cruciate ligament implant: operative procedure and early results

This paper describes the surgical method and instruments for placing and anchoring the Apex polyester fibre anterior cruciate ligament (ACL) reconstruction. It then reviews the early clinical findings and describes recent developments. At the time of review, 172 Apex replacements had been implanted in the UK in arthroscopically proven chronic ACL-deficient knees. These had been inserted at eight centres since 1987, and follow up was by a single observer assessing patients by questionnaire, clinical examination, stress X-ray and KT 1000 arthrometer. Patients less than 12 months from surgery were excluded, leaving 95 with a mean follow up of 27 months (range 13 to 66 months) on whom results are based. Assessment showed improved stability after operation and the Apex implant appears to provide a reliable method of stabilizing the ACL deficient knee within the confines of this short-term review. The authors feel that further trials are justified.     

Social support, rheumatoid arthritis and quality of life: concepts, measurement and research

In recent years, medical technology has improved considerably and the possibilities to replace destructed parts of the body that have been affected by rheumatoid arthritis (RA), have grown also. However, the availability and application of advanced techniques does not automatically entail an improvement of quality of life of individuals. Although the physical (dis)ability of RA patients very often leads to certain restrictions, it is not the only element in the evaluation of life-as-a-whole. The way in which the RA patient copes with the uncertainty of tomorrow and the management of pain and fatigue is another important element in evaluating quality of life. Beside personality factors, social network and social support are regarded to play an important role in this respect and subsequently in the well-being of individuals in general, and especially where it concerns individuals suffering from a chronic disease. Today, a growing number of evidence of the beneficial impact of social support is available of which some of them are discussed.     

The impact of a peer support group for children with rheumatic heart disease in Uganda

Objective

To assess the impact of a peer-support group on knowledge, quality of life, and social support for children with rheumatic heart disease (RHD).

A comparison of learning algorithms for Bayesian networks: a case study based on data from an emergency medical service

Due to the uncertainty of many of the factors that influence the performance of an emergency medical service, we propose using Bayesian networks to model this kind of system. We use different algorithms for learning Bayesian networks in order to build several models, from the hospital manager’s point of view, and apply them to the specific case of the emergency service of a Spanish hospital. This first study of a real problem includes preliminary data processing, the experiments carried out, the comparison of the algorithms from different perspectives, and some potential uses of Bayesian networks for management problems in the health service.     

Progress toward a new injury severity characterization: Severity profiles

Presented is a new seven-dimensional injury severity profile. The profile includes three physiologic assessments and four variables which express the number, location, and severity of a patient's injuries in terms of ‘Abbreviated injury scale’ values. The physiologic assessments are coded values for the ‘Glasgow coma scale’, systolic blood pressure, and respiratory rate.

Also presented are survival-death predictive values of a cluster model based on survival rates of clusters of profiles of 2569 blunt-injured and penetrating-injured patients. The cluster model has a relative information gain (R) of 0.90. R is a measure of predictive value relative to an infallible predictor. It varies from 0 to 1, the higher the value the better the predictive value. The model had 26 false negatives (deaths predicted to survive) and 35 false positives (survivors predicted to die) giving rise to a false negative rate of 9.3%, a false positive rate of 1.4% and a misclassification rate of 2.4%. The R value and false negative rate are particularly noteworthy, the R value being higher than, and the false negative rate much lower than typical values of 30–40% achieved by TRISS (a combination index based on trauma score, injury severity score and patient age).

Also noteworthy is that the clustering was independent of survival/death outcome information and that the good results were achieved even though patient age has not yet been incorporated into the model.     

The fat pad and its relationship to anterior knee pain

The fat pad in the anterior compartment of the knee is often implicated as a cause of anterior knee joint pain. The actual role of this structure remains unclear. The fat pad was clinically implicated in a retrospective review of 53 patients with various knee joint conditions. For the sake of presentation, the patients were divided into various groups which included patients with patellar tendonitis, cruciate ligament surgery, meniscal surgery and a miscellaneous group of patients. Their age group varied between 17 and 67 years. The follow-up was between 4 weeks and 5 years. All these patients presented with pain and/or stiffnes which was related in part to the fat pad pathology. Such a finding was proven by an injection of a cocktail of local anaesthetic and steroid into the fat pad itself which was followed by a transient though complete symptomatic relief due to the effect of the local anaesthetic. Primary fat pad pathology is rare as we propose that fat pad pathology is more commonly secondary to other knee joint pathology. We also suggest that pain produced by the fat pad may have serious implications on knee joint function if not dealt with promptly.     

Health status, adherence with health recommendations, self-efficacy and social support in patients with rheumatoid arthritis

A study was performed in 86 patients with rheumatoid arthritis (RA) to assess their health problems, the problems they experience in adhering to health recommendations and the relationships of these problems with self-efficacy and social support. Feeling dependent, disability and pain were the most important health related problems. The results showed self-efficacy to be related to the subjective experience of health status as measured by DUTCH-AIMS. Social emotional support was not related to health status and contrary to what we expected social instrumental support was positively related to health status. The majority of the patients (55%) experienced adherence problems with health recommendations. These problems were not related to functional incapacity, pain or other aspects of health status but to the patient's self-efficacy expectations about coping with arthritis. Our conclusion is that to improve the self-management of disability and pain and adherence to health recommendations, patient education should be aimed at strengthening self-efficacy expectations in which social emotional support might be a motivating factor.     

Health locus of control, self-help and treatment adherence in relation to ankylosing spondylitis patients

Ankylosing spondylitis (AS) is a form of arthritis characterised by an early onset and an active style of treatment involving regular exercise. Self-help groups for AS patients have developed in many countries as a means of promoting exercise treatment. The empirical section presents a comparative study of members and non-members of such groups along psychosocial dimensions including health locus of control, social support, and health behaviour. Self-help group members were distinguished by a combination of factors including a low reliance on powerful others health locus of control beliefs, greater satisfaction with available support, and increased frequency of exercise. A subsample showed improvements on physiological measurements over a 6-month period. The utility of including psychosocial variables in examination of rheumatic diseases is discussed and practical implications of these findings for health care professionals and future research are considered.     

The time-variable photoplethysmographic signal; dependence of the heart synchronous signal on wavelength and sample volume

The photoplethysmorgraphic signal (PPG) from forearm skin and the ECG were recorded simultaneously from healthy subjects. The optical signal was derived with a fibre-optic probe which consisted of 61 fibre pairs. The peak-to-peak averaged a.c.-signal was calculated. The dependency of this signal and the signal-to-noise ratio (SNR) on the light wavelength and on sample volume was studied. The light intensities used at 560 nm were 0.015 and 0.029 mWmm⁻² and at 940 nm we used 0.029, 1.37 and 2.77 mWmm⁻². A theoretical model for calculation of the sample volumes was also developed. The amplitude and SNR of the a.c.-signal at 560 nm is larger than at 940 nm at the same intensity (0.029 mWmm⁻²). At 940 nm using 1.37 and 2.77 mWmm⁻² the a.c.-signal increased with the number of fibre pairs (volume) while the SNR was little affected. At 560 nm it is suggested that the major contribution to the a.c.-signal is pulsations in the ascending arterioles and at 940 nm from pulsations in the larger vessels deeper in the tissue volume under study.     

The evaluation of mass densities of the human body in vivi from CT Scans

An experimental method, using the CT Scanner, has been developed to evaluate the mass densities of the human body in vivo. This method iis based on theories used in computerized tomography: the concept of average effective energy (AEE), the Fourier Convolution Method in picture reconstruction, and the relationship between the numerical values of a material in a CT scan and the properties of the material. Using this method, various mass densities both of plastics obtained from phantom scans and also of tissues from patient scans were tabulated. The results compared very favorably to known values.     

影响退休干部生活满意度的主观因素分析

对生活质量的评价有两种态度 :客观评价法和主观评价法。近年的研究结果让人越来越倾向于主观评价法[1] ,即自觉幸福度或生活满意度。国内有关这方面的研究已形成热点 ,对老年人生活满意度的研究也有不少[2 - 4] ,但对影响老年人生活满意度的心理社会因素的较全面的研究不多 ,涉及社会支持和应对方式的则更少 ,本文旨在探讨影响老年生活满意度的各种客观条件及心理中介因素 ,包括应对方式和社会支持 ,并运用多元逐步回归法筛选出影响作用较大的几个重要因素。1　对象和方法1.1　研究对象研究对象为军队及地方的退休干部共 2 4 4人 ,年龄为 6…     

Impaired ovarian function and risk factors for atherosclerosis in premenopausal women

Objectives: The aim of the study was to obtain information on the possible relationship between impaired ovarian function and risk factors for cardiovascular disease. Material and methods: Serum lipid levels, plasma fibrinolytic potential and histological and biochemical changes in the intima of the uterine artery were investigated in premenopausal women with irregular menstrual cycles, and the results were compared with those from regularly menstruating women. In addition, the same parameters were studied in postmenopausal women on hormone replacement therapy (HRT) and in postmenopausal women who had never used HRT. In total 64 patients undergoing hysterectomy for benign reasons were included the study. Results: Plasma fibrinogen concentration was significantly higher in irregularly menstruating women as compared with women with regular cycles. In women with irregular cycles thickened or sclerotic arterial intima was a significantly more common finding as compared with regularly menstruating women. A significant positive correlation was observed between plasma fibrinogen concentration and intimal esterified cholesterol content in women with thickened or sclerotic uterine artery. Conclusions: These data suggest an important role for normal ovarian function in the prevention of atherosclerosis.     

The fundamental chemistry of life : An attempt to define and identify the basic reaction responsible for life''s creation and evolution

All natural growth follows exponential characteristics which vary from a simple exponential equation (non-solid cancer, bacteria) to complex Gompertzian functions describing solid cancer and multicellular organisms. Like all chemical processes the reagents (energy sources of food) react during life to produce vital energy, but in addition also create the next generation of life. This latter reaction is unique in that a simple proportional increase in the reagents creates an exponential increase in products: it is the sole invariable criterion of all life. The target of combined ionising and non-ionising radiations in cancer cells appears to be identical with this fundamental exponential chemical reaction. Identification of this target as a system of anaerobic glycolysis suggests that life's first reaction is a unique one whereby a simple proportional increase in available glucose causes an exponential proportional increase in energy which is available solely for reproduction.     

基于心电-脉搏波的心血管疾病识别研究

为实现心血管疾病的早期筛查,降低心血管疾病临床检测的成本。本研究基于上肢脉搏波传导速度（PWV）及脉搏波相关血液动力学基础理论,采集了总计51人的脉搏波与心电信号数据,提取了包括3种PWV和脉搏波特征参数总计16个特征参数,将不同的PWV与脉搏波特征组成3个样本特征数据集,分别建立了基于K近邻学习（KNN）和支持向量机（SVM）的心血管疾病识别模型。KNN模型分类准确率为66.28%,SVM模型分类准确率为84.3%,并通过对比不同PWV对模型性能的影响,确定了用于血管评估的最优脉搏波传导速度pwvm。研究表明基于SVM建立的分类模型对心血管疾病识别有一定可靠性,为低成本的心血管疾病早期筛查提供了新思路,也为穿戴式心血管系统监测提供了基础。     

The primary structure and specificity determining residues displayed by recombinant salmon antibody domains

Previously, single chain fragments of salmon (Salmo salar L.) immunoglobulin variable regions (scFv) were isolated by reactivity towards trinitrophenyl (TNP) or fluorescein (FITC) using phage display technology. The fine specificity of six scFv clones were analysed by ELISA, while the primary structure was determined by DNA sequencing. In addition, preliminary models of one anti-TNP and one anti-FITC clone were built. Here, a follow-up analysis of the primary and tertiary structure of all six clones is focused on the structural basis for hapten specificity. Tertiary structure was analysed by molecular modelling of the antigen combining site. The analysis shows that reactivity to each hapten is maintained by a number of different combinations of VH, D, JH and VL sequences. Accordingly, various sizes of CDR3 on both the heavy and light chain and CDR2 of IgH may support TNP binding. Due to variability of the antigen combining site each clone probably has a distinct binding affinity. However, a feature common among the four scFv antibodies that recognise TNP is a positively charged Arg in CDR2 of either the heavy or light chain. In the majority of the anti-TNP clones localisation of this side-chain is stabilised by a negatively charged Asp in LCDR1. In addition, a Trp in LCDR3 is conserved in all the anti-TNP clones. Also, the anti-FITC clones display a Trp in the LCDR3, suggesting its participation in binding of FITC as well. In combination with a large aromatic amino acid near the N-terminus of HCDR2 and a positively charged Arg in CDR1, these residues probably determine both specificity and affinity towards the FITC moiety.     

Differentiation between two diseases using a programmable hand-held calculator and Bayes'' theorem: Application to Crohn''s disease and ulcerative colitis

A short general program is presented for the Hewlett-Packard HP-41C programmable pocket calculator that calculates posterior probabilities of two diseases on the basis of frequencies of nosographic characteristics using Bayes' theorem. Extended memory and functions modules allow the storage of many data in an ASCII file.     

The design and performance of an experimental external fixation device with load transducers

It is becoming increasingly common that fracture healing is modelled in the laboratory with an osteotomy in the diaphysis of the ovine tibia. External fixation is often used to hold the bones in these models, presenting the problem that the loads on such devices are poorly understood. To help investigate this, a unilateral device has been developed which is capable of measuring the two components of load considered to be the most important, that of axial compression and bending in the plane of the fixator. The device was found to be a rigid system and easy to apply, with the in-vivo measurements being straightforward. The estimated limits of error of the compression transducer are +37.9 N and −21.4 N and those of the bending transducer are +3.6 Nm and −4.2 Nm. Preliminary measurements showed the maximum load during normal walking to 345 N compression and 28 Nm in-plane bending.     

Phenytoin, hemorrhage, skeletal defects and vitamin K in the newborn

The vitamin K-dependent hemostatic factors are present in reduced quantities at birth and may decrease further in the first few days of life. Administration of vitamin K1 on day 1 prevents hemorrhagic disease of the newborn. Maternal ingestion of anticonvulsants puts the newborn at greater risk from hemorrhage, possibly as a result of induction of fetal microsomal enzymes with a resultant increased oxidative degradation of vitamin K which gives rise to a vitamin K deficiency and other concomitant clinical results, for example skeletal defects. Evidence for this sequence of events is presented and the widespread effect of vitamin K deficiency on the fetus is discussed.