Habit-based workplace physical activity intervention: a pilot study.

BACKGROUND: Increasing workplace physical activity has important implications for workers' health and well-being. However, few interventions targeting physical activity in the workplace are grounded in behavioural theory. AIMS: The aim of this study was to develop and pilot a 6-week habit-based intervention designed to promote the development of workplace physical activity habits and increase average weekly step counts. Changes in the strength of workplace physical activity habit and weekly step counts were assessed at 1 and 6 weeks following the intervention. METHODS: The study was a prospective three-wave within-subjects single-arm intervention study that ran for 12 weeks (baseline, 7 weeks, 12 weeks). During the 6-week intervention, participants received information regarding 10 top tips (10TT) to increase and promote habit formation and wore a pedometer during work hours. Differences in workplace physical activity habit and weekly step counts were compared across baseline (T1), 1 (T2) and 6 weeks (T3) post-intervention using repeated measures analyses of variance. RESULTS: Data from 20 sedentary office workers at a large Australian University were included. The average strength of workplace physical activity habits significantly increased from baseline (M = 3.90) to 1 week post-intervention (M = 4.45), and these effects were maintained 6 weeks later (M = 4.72). No significant increase in step counts were observed across any of the time points (all P > 0.05). CONCLUSIONS: The results of this pilot study reveal that workplace physical activity habits can be strengthened via a habit-based intervention. Further research is needed to replicate these findings in larger cohorts of office workers.

Are doctors the structural weakness in the e-health building?

Progressive evaluations by the Organization for Economic Co-operation and Development (OECD) demonstrate that health care is now or becoming unaffordable. This means nations must change the way they manage health care. The costly nature of health care in most nations, as a percentage of Gross Domestic Product (GDP) seems independent of the national funding models. Increasing evidence is demonstrating that the lack of involvement by clinicians (doctors, nurses, pharmacists, ancillary care and patients) in e-health projects is a major factor for the costly failures of many of these projects. The essential change in focus required to improve healthcare delivery using e-health technologies has to be on clinical care. To achieve this change clinicians must be involved at all stages of e-health implementations. From a clinicians perspective medicine is not a business. Our business is clinical medicine and e-health must be focussed on clinical decision making. This paper views the roles of physicians in e-health structural reforms.

Health workforce changes and the roles of information technology associated with these changes. "The Times They Are A-Changin' " (Bob Dylan, 1964).

Healthcare is considered a service profession and most of what clinicians do is manage information. Thus, information is not a necessary adjunct to care. It is care and effective patient management that require effective management of patients' clinical data. This perspective is supported by the World Health Organisation in its use of the quotation from Gonzalo Vecina Neto, head of the Brazilian National Health Regulatory Agency, 'There is no health without management, and there is no management without information'. This opinion paper discusses how traditional clinical decision-making led 'by the doctor' is unsustainable in the modern era and how e-technologies will facilitate distributed effective decision-making and new divisions of labour across the health workforce.

Early implementation of antifungal therapy in the management of febrile neutropenia is associated with favourable outcome during induction chemotherapy for acute leukaemias.

BACKGROUND: Mortality related to induction chemotherapy during the treatment of acute leukaemias (AL) has been estimated at 5-20%, and this increases with age. Fungal infection remains one of the major causes of morbidity and mortality and is considered an obstacle to the successful management of acute leukaemias. METHODS: We retrospectively analysed all patients treated for acute leukaemias at a single institution between July 2006 and January 2009, to assess the impact of early antifungal therapy on outcome during induction chemotherapy. There were 44 episodes of induction chemotherapy, with a median age of patients of 61 years (range 18-81), including 29 patients with acute myeloid leukaemia, 9 with acute lymphoblastic leukaemia and 6 with relapsed AL. The median age was 61 years (range 18-81), and 20 patients were over the age of 60 years. RESULTS: All patients who developed febrile neutropenia received broad-spectrum antibiotics. Early empirical antifungal treatment was commenced with voriconazole (15 patients) or caspofungin (12 patients) if the febrile neutropenia did not resolve after 72 h of antibiotic therapy, in conjunction with radiological changes consistent with possible fungal infection. None of the patients succumbed during induction chemotherapy. The 120-day mortality rate after the induction therapy was 2.2%, without any incidence of invasive fungal disease. CONCLUSION: Our analysis shows that early empirical treatment for fungal infection with voriconazole or caspofungin is associated with a favourable outcome of induction therapy for acute leukaemias. Further studies to confirm this finding are warranted.

The use of existing low-cost technologies to enhance the medical record documentation using a summary patient record [SPR].

The Institute of Medicine has described the Electronic Medical Record [EMR] as an essential technology for health care that improves patient safety and the quality of care when compared to traditional paper-based records. [1,2,3] Despite major financial expenditures on health information technology related to EMRs in developed countries such as North America, Britain and Australia, success rates for successful implementations have been low. One specific domain of information management relates to the communication of health care between those involved in the care process. Summarization of patient histories is a core component of EMR systems and assists in the communication of health care. This paper demonstrates how the utilization of simple technologies, can lead to the successful implementation of the Summary Patient Record [SPR] component of an EMR system.

The MOSORIOT medical record system (MMRS) phase I to phase II implementation: an outpatient computer-based medical record system in rural Kenya.

The authors of this paper describe the second phase of the implementation of the Mosoriot Medical Record System (MMRS) in a remote health care facility on the outskirts of Eldoret, Kenya, located in sub-Saharan Africa. We describe of the collaboration between Indiana University (IU) and the Moi University (MU), and the process that led to the development of the computer-based Mosoriot Medical Record System (MMRS) is provided. We then provide the conceptualization and initial implementation of this basic electronic medical record system. We also describe the different processes for assessing the MMRS' effects on health care, including time-motion studies and a strict implementation plan that is necessary for the successful implementation of the system. The MMRS project has many features that make it significant in the domain of CBPR systems. It may serve as a model for establishing similar, basic electronic record systems in the developed and developing world. In developing countries there are few (if any) projects that have attempted to implement such a system. This paper describes the planning, end-user education to new technologies, and time-motion studies necessary for the successful implementation of the MMRS. The system will be used to improve the quality of health data collection and subsequently patient care. It will also be used to link data from ongoing public health surveys and this can be used in public health research programs of the Moi University.

The Mosoriot medical record system: design and initial implementation of an outpatient electronic record system in rural Kenya.

Mosoriot Health Center is a rural primary care facility situated on the outskirts of Eldoret, Kenya in sub-Saharan Africa. The region is characterised by widespread poverty and a very poor technology infrastructure. Many houses do not have electricity, telephones or tap water. The health center does have electricity and tap water. In a collaborative project between Indiana University and the Moi University Faculty of Health Sciences (MUFHS), we designed a core electronic medical record system within the Mosoriot Health Center, with the intention of improving the quality of health data collection and, subsequently, patient care. The electronic medical record system will also be used to link clinical data from the health center to information collected from the public health surveys performed by medical students participating in the public health research programs of Moi University. This paper describes the processes involved in the development of the computer-based Mosoriot medical record system (MMRS) up to the point of implementation. It particularly focuses on the decisions and trade-offs that must be made when introducing this technology into an established health care system in a developing country.

The Westmead Pediatric TBI Multidisciplinary Outcome study: use of functional outcomes data to determine resource prioritization.

OBJECTIVE: To measure functional outcome in the 2 years after traumatic brain injury (TBI) in 2 groups of children and to determine the usefulness of a TBI severity classification system for resource allocation. DESIGN: Prospective inception cohort study with 3 assessment points during the 2 years after trauma. SETTING: Tertiary pediatric trauma center in Sydney, Australia. PARTICIPANTS: Eighty-one consecutive admissions aged 0 to 14 years. Fifty-one were allocated to the Mild (n = 26) or Severe (n = 25) TBI groups, according to preset determinants of severity; 30 admissions with non-TBI trauma constituted the control group. MAIN OUTCOME MEASURES: Standardized psychometric and clinical assessments of cognition, communication and feeding ability, motor performance (ambulation, fine and gross motor), neurologic status, self-care independence, and school/academic performance. RESULTS: Those with Mild TBI severity had no significant deficits at the 2-year data point. In contrast, those in the Severe TBI group demonstrated continued problems with fine motor performance, neurologic status, self care, and school/academic performance. CONCLUSIONS: A classification system has been developed that may be useful in the allocation of children with a TBI, age younger than 15 years, to 1 of 2 severity groups early in their rehabilitation. This classification system may be useful in determining areas of high and low resource prioritization.

Detecting adverse drug reactions to improve patient outcomes.

Adverse drug reactions and inappropriate administration of medications account for poor outcomes for patients. They place patients in life-threatening situations, lead to increased health care costs, extend length of stay in hospitals, as well as increasing litigation. This paper will highlight the incidence of adverse drug events (ADE) in health care and show the low rate of detection within conventional medical records. I will also show how electronic medical records (EMR) improve detection of ADE, enhance clinician compliance to their management, improve patient outcomes, and reduce health care costs.

Variation in health care--the roles of the electronic medical record.

Variation in the use of clinical resources, outcomes, costs, access to health care and quality is a well recognized, ever present feature of health care. It is a phenomenon that affects all sectors of the health care delivery process and is important to clinicians, administrators and patients. As a phenomenon variation can be appropriate or inappropriate and the elimination of inappropriate variation is a fundamental principal behind continuous quality improvement in health care. The primary tools for the management of variation exists within the electronic medical record (EMR). The EMR utilizes the existing and evolving information storage technologies (data repositories) and information management tools (applications), to integrate the elements within this long-term data storage. Through this integration the EMR systems are able to provide knowledge representation in differing formats to the decision-makers and this will facilitate more accurate and appropriate decision-making with subsequent improvements in health care delivery.

Transporting an electronic patient record system across international boundaries--the lessons learnt.

This paper will outline the tasks involved, completed and not achieved over an eight year period involving the implementation of the Johns Hopkins Oncology Center Information System (OCIS) in an oncology department of a secondary/tertiary care hospital in Australia.

Relationships between symptom relief, quality of life, and satisfaction with hospice care.

Hospices were founded to alleviate suffering at the end of life. Quality improvement in hospices should, therefore, target patients' subjective assessments of their care and its outcomes. However, little is known about the relationships among subjective measures of care among hospice patients. The aim was to assess the relationships between hospice patients' physical and psychological symptoms, quality of life, and satisfaction with inpatient care. This was achieved with a prospective cohort study of 42 patients admitted to an Australian hospice's inpatient service during a two-month study period. The Edmonton symptom assessment system, McGill quality of life questionnaire, and a new measure of patients satisfaction with hospice inpatient care were used. It was shown that while there were marked variations in symptoms and quality of life scores, most patients were satisfied with their care. Satisfaction on the day after admission was lower among patients with worse quality of life scores (r = -0.40, P = 0.008), but there was no correlation with symptoms (r = -0.12, P = 0.43). Among the 26 patients (62%) with at least one subsequent inpatient interview, satisfaction was correlated with both worse quality of life (r = -0.51, P = 0.01) and symptoms (r = -0.41, P = 0.05). The symptom, quality of life, and satisfaction scales all had sufficient precision to identify patients with significant changes between the two interviews. It can be concluded that satisfaction with hospice care was associated with quality of life more than symptoms, although symptoms became important later during inpatient stays. Patients can assess their care and can provide valuable information for improving palliative care.

International transfer of the Johns Hopkins Oncology Center clinical information system.

The transfer of the Johns Hopkins Oncology Center clinical information system to an Australian tertiary care center began in 1982. The converted system was installed for use by the hospital administration in 1991, and it is now used extensively in management and patient care. This article discusses the original software, the applications implemented, and the problems encountered and overcome, as well as the role of the hospital administration in the development and subsequent freezing of the system.

Maternal views of preterm infants' responsiveness to social interaction.

Mothers of 47 very low birth weight ( < 1,500 gram) infants were interviewed concerning their feelings and views about interactions with them. Interviews were conducted within the first ten days and again three to five weeks after birth. Over the first month of the baby's hospitalization, mothers significantly increased their pleasure in interacting, knowledge of infant cues, and perception that their infants were responding. The most frequently mentioned behaviors were maternal talking and touching and infant eye opening and body activity. Many mothers appeared to be utilizing their infants' behaviors as a guide for their own behaviors and reported that their infants' behaviors had specific meanings. However, an equal number of mothers were not ascribing meaning to their infants' behaviors and did not appear to be using behavioral cues. These findings have implications for interventions by neonatal nurses.