Experiences of technology integration in home care nursing.

The infusion of health care technologies into the home leads to substantial changes in the nature of work for home care nurses and their patients. Nurses and nursing practice must change to capitalize on these innovations. As part of a randomized field experiment evaluating web-based support for home care of patients with chronic heart disease, we engaged nine nurses in a dialogue about their experience integrating this modification of care delivery into their practice. They shared their perceptions of the work they needed to do and their perceptions and expectations for patients and themselves in using technologies to promote and manage self-care. We document three overarching themes that identify preexisting factors that influenced integration or represent the consequences of technology integration into home care: doing tasks differently, making accommodations in the home for devices and computers, and being mindful of existing expectations and skills of both nurses and patients.

Use of a matrix to select home-based technology for HeartCare II.

Access to consumer health informatics innovations requires availability of certain technical resources. We discuss the use of a decision analysis matrix in selecting technology for home use by participants in the HeartCare II project, a web-based resource for patients managing congestive heart failure. The matrix provided the structure for collecting, displaying, and comparing data about the requisite criteria for the technology. Its utility for a variety of decision problems with dissimilar data elements is posited.

Endometrial adenocarcinoma--presenting pathology is a poor guide to surgical management.

We aimed to evaluate the correlation between the histological grade of endometrial cancer diagnosed on endometrial biopsy or curettage, with the definitive grade and stage of lesion as determined by surgery and histopathological examination and to make recommendations about the suitability of conservative surgery based on pre-operative determination of the grade of endometrial adenocarcinoma. A retrospective review of all patients with endometrial adenocarcinoma presenting to the Queensland Centre for Gynaecological Cancer from 1 January 1996 to 31 December 1998 was undertaken. Clinical and pathological data was abstracted from medical records and case notes of 460 patients. All histological specimens were prospectively reviewed by a panel consisting of gynaecologic pathologists, gynaecologic oncologists and other doctors involved in the treatment of patients with gynaecological malignancies. The percentage of patients whose management would have been optimised by full surgical staging at the time of initial surgery was calculated. Only 60%, 71%, and 84 % of the patients with a presenting diagnosis of grade 1, 2 and 3 endometrial adenocarcinomas respectively had this confirmed on final histopathology. Furthermore, using established criteria, 30%, 46% and 100% of patients presenting with grade 1, 2 and 3 endometrial adenocarcinoma required full surgical staging at the time of their primary surgery There is poor correlation between the pre-operative grade of endometrial cancer and the grade as determined on analysis of the resected uterus. The correlation is poorest with grade 1 endometrial adenocarcinoma, where strongest consideration is given to conservative surgery and the avoidance of subspecialty referral. There is a strong argument that all patients with a diagnosis of endometrial cancer made on endometrial biopsy or curettage, regardless of grade of malignancy, should be offered surgery where the option to perform concurrent comprehensive surgical staging is available.

A clinicopathologic study of glandular dysplasia of the cervix.

With the increasing incidence of cervical adenocarcinoma there is a growing interest in the detection and treatment of glandular precursors. A major obstacle to this research is that endocervical glandular dysplasia (EGD) is rare and infrequently reported. From a study of 30 patients it appears that EGD often occurs with concomitant squamous dysplasia and also benign and preinvasive glandular changes in the cervix and endometrium. If EGD is detected on cervical biopsy hysteroscopy, dilatation and curettage and cone biopsy should be performed.

The use of intraoperative ultrasound in the management of a perforated uterus with retained products of conception.

The benefits of non-invasive, correctly-directed instrumentation coupled with an ability to predict complete evacuation of the uterus can make intraoperative ultrasound an important addition in the continued and improved care of women with a perforated uterus and retained products of conception. Two such cases are reported.

A pain in the neck in pregnancy: cervical spinal tuberculosis.

This paper describes a case of spinal tuberculosis diagnosed at 29 weeks' gestation in a primigravid Indian woman. The report illustrates the primary problems in suspecting disease, recognizing the diverse clinical presentations and initiating investigations to confirm the diagnosis. In most cases, M. tuberculosis, once recognized and appropriately treated, should result in an excellent prognosis.

Management guidelines for M. tuberculosis in pregnancy.

Unrecognized M. tuberculosis in pregnancy can have an adverse outcome for women and their babies. With world-wide trends of increasing incidence of M. tuberculosis and increasing migration to Australia of women of childbearing age from countries with a high incidence of this disease, it is imperative that clinicians recognize and be aware of appropriate management of the disease. Management guidelines for M. tuberculosis occurring in pregnancy are outlined.

ComputerLink: the impact of a computer network on Alzheimer's caregivers' decision-making confidence and skill.

1. INTRODUCTION. Decision-making demands faced by homebound caregivers of persons with Alzheimer's Disease (AD) are numerous and complex. Although caregivers frequently know what to do in caring for the person with AD, they lack confidence in their decisions [1]. The challenge of caregiving decisions may be compounded by the lack of resources to aid in decision-making or affirm decisions made. Because many caregivers are homebound, they are unable to avail themselves of traditional health and social services. ComputerLink, computer network, was designed to address the needs of these homebound caregivers. 2. DESCRIPTION. The ComputerLink consisted of a set of specialized programs and utilities residing within a public computer network. The three main features of the ComputerLink, which may provide aid to caregivers in decision making, include: the electronic encyclopedia (EE); a communications utility composed of a question and answer bulletin board (Q&A) and public (Forum) and private mail services; and a decision support module (DSM). The EE contained illness-specific information to support decision-making. The Forum and private mail provided caregivers with a means to interact with peers and professionals about their caregiving decisions. Q&A provided the opportunity to ask questions about caregiving and receive feedback from professionals and peers. The DSM could be accessed to gain information about decision-making or to actually work through a decision problem. The DSM was built on a multi-attribute utility model which employed English-language questions to guide users through a decision analysis. The analysis strategy was designed to help the user focus on the values and trade-offs that occur during difficult choices. The impact of ComputerLink on decision confidence and skill was evaluated as part of a larger randomized experiment. 102 AD caregivers were recruited: 51 caregivers in the control group and 47 in the experimental group completed the 12-month study. The mean age of the caregivers was 60 years. Thirty-three percent were male and 28 percent were Black. The groups did not differ in demographic characteristics. The ComputerLink interface was menu-driven and the system was available 24 hours. ComputerLink use was captured through a passive monitoring system. AD caregivers accessed ComputerLink a total of 3,875 times, with a mean access per individual of 83 (range: 3 - 590). The mean length of an encounter was 13 minutes; subjects typically accessed two or more functions during this time. The decision support model was accessed 91 times. The communication functions were most frequently used (3,724 Forum accesses and 1,888 private mail); the information utility was accessed 518 times. 3. RESULTS. Decision confidence was objectively measured using a modification of the Saunders and Courtney confidence-in-decision making instrument. Caregivers who had access to ComputerLink experienced greater confidence in decision-making than caregivers in the control group (t = 2.73, p < .01). Access to ComputerLink did not alter decision skill as measured by the number of alternative solutions generated for two self-identified decisions problems (t = .18, p < .05). Decision-making confidence correlated positively with ComputerLink accesses (r = .32, p = < .02) and with length of time spent on ComputerLink (r = .30, p = < .02). 56% of the AD caregivers reported that use of ComputerLink increased both their confidence and skill in decision making, though only 38 percent reported using the DSM to make a decision. 4. DISCUSSION. Access to ComputerLink increased decision-making confidence, but not decision-making skill in AD caregivers. The impact of ComputerLink on decision confidence, and not skill, may be related to the differential use of the utilities. (abstract truncated)

Vibration in metal and non-metal incubators.

The purpose of this study was to determine the amount of vibration transmitted to the surface of an incubator mattress. Empty incubators with metal (n = 12) and non-metal (n = 12) bases were monitored for vibration levels when the incubators were turned "off" and when they were turned "on." High levels of low-frequency vibration were detected in both types of incubators in both conditions. The metal incubators transmitted significantly less vibration to the mattress than did the non-metal incubators at several frequencies in the "off," the "on," and the "adjusted" conditions. These results suggest that infants experience significant whole-body vibration while lying in incubators.

Single-item indicators in nursing research.

Single-item indicators that ask respondents for their global rating of a specific concept are congruent with nursing's emphasis on wholism and individualism. They allow the subject to take personally salient features of the situation into account when providing a response. The psychometric performance of single-item indicators in published research and in a sample data set using measures of the mother's choice and satisfaction with her employment decision support the validity and reliability of the measures, suggesting that these indicators deserve more attention in nursing research. Recommendations for the use of single-item indicators are provided.

Improving the quality of patient care: the role of patient preferences in the clinical record.

Patients are an important but overlooked participant in health information management. Patients serve as a source of self-monitoring data and for self-report of essential judgments such as preference for treatment and preferences for clinical outcomes. As the deliberations regarding the Computer-Based Patient Record initiative continue, decisions must be made about what patient-specific information will be entered in the record. In consideration of the mounting evidence that patient preferences represent an essential component in many health care decisions, it is timely to advocate for including patient preferences in the patient record. This represents one aspect of the patient role in health care information management.