Confidential Manner Research Articles

A user-centered model for web site design: needs assessment, user interface design, and rapid prototyping.

As the Internet continues to grow as a delivery medium for health information, the design of effective Web sites becomes increasingly important. In this paper, the authors provide an overview of one effective model for Web site design, a user-centered process that includes techniques for needs assessment, goal/task analysis, user interface design, and rapid prototyping. They detail how this approach was employed to design a family health history Web site, Health Heritage <www.healthheritage.net>. This Web site helps patients record and maintain their family health histories in a secure, confidential manner. It also supports primary care physicians through analysis of health histories, identification of potential risks, and provision of health care recommendations. Visual examples of the design process are provided to show how the use of this model resulted in an easy-to-use Web site that is likely to meet user needs. The model is effective across diverse content arenas and is appropriate for applications in varied media.

Software tools to support incident reporting in safety-critical systems

Incident reporting systems are playing an increasingly important role in the development and maintenance of safety-critical applications. The perceived success of the FAA's Aviation Safety Reporting System (ASRS) and the FDA's MedWatch has led to the establishment of similar national and international schemes. These enable individuals and groups to report their safety concerns in a confidential or anonymous manner. Unfortunately, many of these systems are becoming victims of their own success. The ASRS and MedWatch have both now received over 500,000 submissions. In consequence, the administrators of incident reporting systems increasingly rely upon software tools to support the administration of their systems. In the past, these systems have relied upon ad hoc applications of conventional database technology. However, there are several reasons why this technology is inadequate for many large-scale reporting schemes. In particular, the problems of query formation often result in poor precision and recall. This, in turn, has profound implications for safety-critical applications. Users may fail to identify similar incidents within national or international collections. These ad hoc approaches also neglect the opportunities provided by recent developments in computer assisted interviewing and in the monitoring of retrieval activities to build models of user behavior. These techniques offer a number of potential benefits. For instance, it is possible to automatically detect potential biases in the way that investigators analyze particular incidents.

Creatine use among young athletes.

Creatine is a nutritional supplement that is purported to be a safe ergogenic aid in adults. Although as many as 28% of collegiate athletes admit taking creatine, there is little information about creatine use or potential health risk in children and adolescents. Although the use of creatine is not recommended in people less than 18 years of age, numerous anecdotal reports indicate widespread use in young athletes. The purpose of this study was to determine the frequency, risk factors, and demographics of creatine use among middle and high school student athletes. Before their annual sports preparticipation physical examinations, middle and high school athletes aged 10 to 18 in Westchester County, a suburb north of New York City, were surveyed in a confidential manner. Information was collected regarding school grade, gender, specific sport participation, and creatine use. Overall, 62 of 1103 participants (5.6%) admitted taking creatine. Creatine use was reported in every grade, from 6 to 12. Forty-four percent of grade 12 athletes surveyed reported using creatine. Creatine use was significantly more common (P <.001) among boys (53/604, 8.8%) than girls (9/492, 1.8%). Although creatine was taken by participants in every sport, use was significantly more common among football players, wrestlers, hockey players, gymnasts, and lacrosse players (P <.001 for all). The most common reasons cited for taking creatine were enhanced performance (74.2% of users) and improved appearance (61.3%), and the most common reason cited for not taking creatine was safety (45.7% of nonusers). Despite current recommendations against use in adolescents less than 18 years old, creatine is being used by middle and high school athletes at all grade levels. The prevalence in grades 11 and 12 approaches levels reported among collegiate athletes. Until the safety of creatine can be established in adolescents, the use of this product should be discouraged.

Female adolescent sexuality: Promoting healthy sexual development

Health care providers must recognize the specific challenges and rewards of providing services for adolescents. Quality care begins with the establishment of trust, respect, and confidentiality between the health care provider and the adolescent. Data suggest that the normal age for beginning puberty is decreasing, which has important clinical, educational, and social implications. The health care provider should be aware of the broad range of potential sexual behaviors involving adolescents, as well as the teen's acceptance of such behaviors, often dictated by age, gender, culture, and education. When providing gynecologic care to adolescent girls, the physician should not only provide contraception and screen for sexually transmitted diseases but should contribute to the development of the patient's sexual health. Especially when providing care for the younger teen, the health care provider must focus on involving a member of the family or another significant adult to provide needed support and guidance. Anticipatory guidance for parents should focus on assessing their parenting styles and promoting supervision. Although parents should strive to maintain open communication with their adolescents, they may not accurately estimate the sexual activity of and the sexual risk for their teenage children. Parents need to be encouraged to consider the implications of their own sexual behaviors. The provider should attempt to foster a comfortable environment in which youth may seek help and support for appropriate medical care while reserving the right to disclose their sexual identity when ready. Health care professionals cannot exclude heterosexual behavior on the basis that a young woman self-identifies as homosexual. Her reported sexual behaviors may not indicate her sexual orientation. Self-definition of sexual orientation is a dynamic process including factors such as fantasies, desires, and behaviors. Self-definition of sexual identity is affected by individual variations in sex, gender, sexual roles, and sexual orientation. Most adolescents want to discuss sexual-related issues with their health care providers and will welcome direct questions about sexual behaviors and possible risks when posed in a confidential and nonmoralistic manner. Discussion of the physical, emotional, familial, and social changes related to adolescence will encourage healthy sexual development.

The ouch! Factor: problems in conducting sensitive research.

Qualitative health research often slams into sensitive barriers in attempting to understand the phenomena under scrutiny. John D. Brewer pointed out that textbooks tend to view areas of sensitivity as purely ethical issues. However, research within sensitive areas requires practical solutions that are not always linked to ethical dilemmas. Practical difficulties abound and demand flexibility and tact on the researcher's part if valuable research is to be carried out. As qualitative researchers, the authors share personal trials and tribulations that have been successfully overcome and integrated into completed research projects. This article outlines some of the problems and pitfalls that may be encountered while conducting sensitive research and offers some ideas that may enable researchers to deal with the "ouch! factor" in a professional and confidential manner. Above all, the authors hold that a sense of humour is one of the essential ingredients for surviving the unexpected ouch! factor.

Microlaparoscopy: a comparative study of diagnostic accuracy

Objective: To investigate the diagnostic accuracy of microlaparoscopy in comparison to laparoscopy with a standard 10-mm laparoscope. Design: Prospective evaluation by two independent observers. Setting: Academic Medical Center. Patient(s): Ten patients scheduled to undergo diagnostic laparoscopy for the indications of infertility and/or chronic pelvic pain. Intervention(s): Two surgeons were present for each operation. Diagnostic laparoscopy was performed using the Microlap 2-mm laparoscope (Imagyn Medical Inc., Laguna Niguel, CA). Standard diagnostic laparoscopy was then performed using a 10-mm laparoscope. After each procedure, each surgeon reported his or her observations in a confidential manner to a third person to record. Main Outcome Measure(s): Endometriosis and adnexal adhesions were staged. Observations made with the microlaparoscope were compared with those obtained with a standard 10mm laparoscope for each surgeon. The observations of both surgeons were also compared with each other's to evaluate interobserver differences. Result(s): Operative findings reported by each individual surgeon using the microlaparoscope correlated with the operative findings reported using the larger laparoscope. Scores for both endometriosis and adnexal adhesions did not differ in any significant way. Endometriosis scores differed by no more than 6 points, and adhesion scores differed by no more than 2 points, with no subsequent change in severity classification for either finding. Furthermore, when comparing the additional operative findings of the two surgeons, no difference was noted when using either the microlaparoscope or a standard 10-mm laparoscope. Conclusion(s): The diagnostic accuracy achieved with microlaparoscopy is comparable to that achieved with standard 10-mm laparoscopy.

Editor's Corner

The present statement in the Instructions to Reviewers for Poultry Science reads as follows: “All manuscripts should be handled in a confidential manner.” However, in view of a pending lawsuit against companies and individuals, as well as a well-known scientific journal (Science Vol. 270, 22 Dec., 1995), a change in the Instructions to Reviewers will occur to make the statement more specific, as follows: “This manuscript is considered privileged communication until published. You should not show it to another person nor photocopy it without receiving written permission from the Section Editor of the section to which it was submitted or from the Editor-in-Chief.”

The scientific basis for using surveillance and risk factor data to reduce nosocomial infection rates

Research over the past 20 years has demonstrated that an active programme of surveillance with feedback of surgical wound infection rates to surgeons can reduce subsequent rates by 30–40%. For surveillance data and feedback to be meaningful and influential, however, certain rigorous methodological principles must be observed. First, surveillance data must be collected in an accurate, efficient and confidential manner. This requires written definitions of infection, regular clinical case-finding, post-discharge follow up for short-staying patients, and computer storage, analysis and reporting of the data in coded form that does not publicly identify individuals. Second, the variation in intrinsic risk of the patients of the various surgeons must be controlled for by stratifying the final infection rates on a multivariate risk index, which combines the traditional classes of wound contamination with measures of intrinsic patient susceptibility. This can be accomplished with a relatively small commitment of time by the Infection Control Nurse with the aid of sophisticated computer software that is now available.

Use of personal medical records for research purposes.

The established practice of doctors using medical records for research purposes is threatened by the recent proposed guidelines from the Department of Health, the BMA, and the European Commission. The European Commission has proposed that explicit consent should be obtained from each patient before his or her medical records can be used; the proposals from the Department of Health and the BMA would require all research that needs access to personal medical records to be submitted to an ethics committee. We believe that these proposals would seriously impair an entire category of research and suggest therefore that another set of guidelines, proposed by a Royal College of Physicians' working group, should be used to modify the proposals. The guidelines of the working group encourage the use of medical records for research and ensure that such use can be made in a confidential manner without causing harm.

Homosexuality and Adolescence

Pediatricians should be aware that some of the youths in their care may be homosexual or have concerns about sexual orientation. Caregivers should provide factual, current, nonjudgmental information in a confidential manner. These youths may present to physicians seeking information about homosexuality, STDs, substance abuse, or various psychosocial difficulties. The pediatrician should ensure that each youth receives a thorough medical history and physical examination (including appropriate laboratory tests), as well as STD (including HIV) counseling and, if necessary, appropriate treatment. The health care professional should also be attentive to various potential psychosocial difficulties and offer counseling or refer for counseling when necessary. The American Academy of Pediatrics reaffirms the physician's responsibility to provide comprehensive health care and guidance for all adolescents, including gay and lesbian adolescents and those young people struggling with issues of sexual orientation. The deadly consequences of AIDS and adolescent suicide underscore the critical need to address and seek to prevent the major physical and mental health problems that confront gay and lesbian youths in their transition to a healthy adulthood.

A New Approach to Eliciting Information about Induced Abortion

Reliable quantitative data on abortion are sorely needed, particularly in developing countries. Past experience in large-scale survey research has demonstrated that direct questioning on this subject results in significant underreporting. This article presents results of an experiment to collect data on induced abortion in Côte d'Ivoire within the context of a family planning operations research study. First, questions were employed to broach the topic of unwanted pregnancy in a value-free manner, and then the potential for a variety of actions, including abortion, was acknowledged. The results indicate that approximately 25 percent of all women attending a family planning clinic on the day of the survey had had an induced abortion. The use of improved abortion-related questions shows promise for providing more complete measurement of a neglected dimension of women's reproductive health.

Understanding and Using Professional Peer-Assistance Programs

The idea of using concerned caring peers to intervene on behalf of another peer who is suffering from the disease of chemical dependency is a rather new concept in our society. However, the idea has produced great success and today we find that most professional societies sponsor a peer-assistance program. Peer programs are easy to access and provide an array of services. Some of the services extend to the entire professional population. Such things as continuing education credit and monitoring of recovering pharmacists for an employer can benefit all members of the profession. Because peer programs work very closely with State Boards of Pharmacy, advocacy can be provided for the recovering pharmacist. A person who feels the need to report a suspected impairment can feel comfortable that the peer committee and the professional licensing board will handle the problem in a fair and confidential manner. Colleagues, coworkers, spouses, or any concerned person should feel good about using the services of a peer-assistance committee. Use of these services can make the difference in saving the professional career or possibly the life of a peer or loved one.

ROLE OF WOMEN IN PREVENTION AND CONTROL OF AIDS

Women in India and AIDS prevention and control are discussed in terms of vulnerability, victimization, required knowledge, reproductive impact, care and prevention after birth, and the demands of the prevailing situation. A WHO world estimate is that 3 million women of childbearing age are infected with HIV out of 8-10 million. Indian women are vulnerable because of their reduced status and lack of power in private and marital life. Also, pregnant women receive blood transfusions, which may be inadequately screened, for anemia. The use of oral contraceptives with estrogen reduces immunity. The use of IUDs may cause inflammation or injury which provides a point of entry for HIV into the bloodstream. Prostitution is an outlet for lack of money, education, and skills, and places women at risk. The transmission from men to women is higher than the reverse. Every women should know their risks and modes of transmission. Women need to know that the risk of fetal infection from an HIV-positive mother is 20-40%, and that the risk is highest if HIV infection occurs or AIDS symptoms occur during pregnancy. Infant mortality from HIV may occur within the 1st several years. The following needs to be understood about reproduction and HIV: the risk of infection is very high when impregnated by an HIV male partner, and if children are desired, artificial insemination should be the preferred method. The reverse holds true, because penetrative sex without a condom allows transmission of the virus. The best option is for avoidance of childbearing if a partner has HIV. Abortion should be provided. Women need to develop the skills in language and confidence to negotiate safer sex, should be particular about choosing a loyal partner, and protect themselves by urging male condom use. The mode of transmission to babies is not from cuddling or handling. Breast feeding carries a meager risk of transmission, and should be continued if HIV infection occurs; the baby should be immunized. All health workers should receive training in order to provide support and care to mother and child in a private and confidential manner. Traditional healers have a role in providing advice on AIDS and condoms, spiritual support, and in changing behavior. Peer counseling is an important strategy for teenagers. There is a great need from society,husbands, and family to change the views of women and sex and to support women. Testing and screening of pregnant women in whom HIV infection is suspected is recommended.

What Private Practitioners Should Know About Employee Assistance Programs and Their Referral Systems

The Employee Assistance Program (EAP) is a carefully thought out, enlightened approach to the problems of what to do with valuable employees who have personal problems interfering with their job performance. EAPs face the personal problems of employees in a confidential manner, diagnose the real problems and get the resources that are necessary to help. The aim is to evaluate and refer into the community. EAP Coordinators have stringent rules on how to select practitioners for referral purposes. Private practitioners have to work together with EAP Coordinators if they are to bring about effective changes in employees with personal problems.

Protecting the Blood Supply

Prevention of the transmission of the acquired immunodeficiency syndrome (AIDS) by transfusion has been the most successful area of epidemiologic control of the disease. Only 2% of the more than 50,000 cases reported to the Centers for Disease Control (CDC) have been attributed to transfusion, and the vast majority of these patients were infected before the introduction of screening tests in April 1985. The overall prevention program involves donor education, adequate medical history, physical examination, and mechanisms that allow exclusion of individuals at risk in a confidential manner. The current screening tests for human immunodeficiency virus (HIV) antibodies are highly sensitive, and the Western blot confirmatory test is highly specific. The present program can be used as a model in screening for other viruses and diseases, and its success has stimulated current work in developing multiple-retrovirus screening tests to detect either several retroviruses simultaneously or elements that are common to all retroviruses.

Silent sequences and the safety of blood transfusions.

Editorials1 June 1988Silent Sequences and the Safety of Blood TransfusionsTHOMAS F. ZUCK, M.D.THOMAS F. ZUCK, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-108-6-895 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe emergence of the acquired immunodeficiency syndrome (AIDS) has fueled concerns of both physicians and their patients about the safety of blood transfusions. In the spring of 1983, after recognizing that AIDS could be transmitted by infusions of blood and blood products, people at increased risk for AIDS were asked not to donate blood or plasma. Testing donated blood and plasma for antibodies to the human immunodeficiency virus (HIV-1), the causative agent of AIDS, was initiated by blood banks in 1985. A method for donors to exclude their units from the blood supply in a confidential manner was instituted in...

School-Based Clinics: A National Conference

On October 9-12, 1985, 250 health personnel, educators, and social service workers attended the 2nd national conference on school based clinics in the US. The conference, held in Chicago, was sponsored jointly by the Center for Population Options (CPO), a Washington based organization which provides technical assistance to groups interested in establishing school clinics, and the Ounce of Prevention Fund, a group of funding agencies in Illinois which works in cooperation with the state government to provide funds for school clinics in Illinois. The growth and accomplishments of the school based clinic movement in the US was reviewed in opening remarks made by the chairperson of the CPO. In 1984, at the time of the 1st national conference, there were clinics in only about 12 communities throughout the nation. Currently, there are clinics in about 50 communities located in 26 states. The clinics provide primary health care, including physical exams, immunizations, treatment for minor illnesses, counseling, nutrition assistance, gynecological exams, and family planning counseling. Some of the clinics dispense contraceptives. Most of the clinics do not provide abortion referrals. The clinics are generally operated by groups outside the educational system, e.g., hospitals, health departments, and nonprofit organizations. The schools furnish space for the clinics. Clinics are usually staffed by a nurse practitioner and a social worker with a backup physician. Topics discussed by the conference participants included strategies for establishing clinics and for gaining community and student acceptance, clinic evaluation, and funding issues. Controversy frequently accompanies the establishment of new clinics. Participants tended to agree that an essential element in launching a successful program is the establishment of a community advisory committee. A concerted effort must be made to address all community concerns about the clinic. Participants noted that it was best to obtain the support of school board members, administrators, and superintendents before approaching the staff at individual schools. Efforts must be made to gain the student's confidence in the ability of the clinics to serve their needs in a confidential manner. This goal can be more effectively met if the clinic is staffed by full-time rather than part-time workers. Some clinics successfully avoided initial controversy by deferring the provision of contraceptive services until their 2nd year of operation. Available but limited evaluation data suggest that clinic utilization is relatively high and that the clinics have had a negative impact on teenage pregnancy and a positive impact on contraceptive use among adolescents. For example, in St. Paul, Minnesota, a school clinic program was introduced in the 1970s, and between 1976-77 and 1984-85, the teenage birth rate declined from 59/1000 to 37/1000. The proportion of female students who used family planning increased from 7%-35% between 1976-77 and 1983-84. During the conference, the CPO announced plans to conduct a much needed large-scale evaluation of school clinics. The 3-year study will cover 7 geographical areas. The cost of operating the clinics is estimated to be US$100-US$125/student. Funding for the clinics comes primarily from the federal government sources including Maternal and Child Health and Social Services block grants, Medicaid, Title X of the Public Health Service Act, and the Adolescent Family Life Act. State governments and private donor organizations also support the clinics. A few clinics offset their expenses by charging minimal student fees. The participants tended to agree that in the long run, public funds should be used to support the programs. There was some disagreement among participants as to whether the primary task of the clinics was to improve the health status of adolescents or reduce the teenage pregnancy rate.

Contraception in Adolescence: An Overview for the Pediatrician

Pediatricians can help prevent unwanted pregnancy among sexually active teenagers by giving them contraceptive advice in a confidential manner. Although oral contraceptives (OC) have been generally regarded as a safe and effective method of contraception the physician should consider the potential problems (estrogen-or progesterone-related side effects; absolute contraindications; other complications) associated with the use of OCs before giving an adolescent a prescription. The suitability of using copper IUDs by teenagers is currently being reevaluated and modifications of basic IUD designs are being made to improve longevity and effectiveness of the device. There are also contraindications (pelvic infections and the like) and complications (increased dysmenorrhea and bleeding) associated with IUD use. The young promiscuous nulliparous IUD user from a low socioeconomic background is particularly at highest risk for developing pelvic inflammatory disease. The barrier methods (diaphragm; condom; vaginal contraceptives) are also used to prevent conception. Pregnancy rates of diaphragm users range from 2.4 to 29/100-woman-years. Diaphragms should be encouraged for adolescent use because of fewer side effects and increased protection from cervical carcinoma associated with it. Contraindications to its use should also be considered. Homosexual youths should be advised that the condom can prevent transmission or acquisition of venereal diseases associated with homosexual life style.

Assessing Your Student Teaching Program

Each quarter, for the past five years, the student teaching program at Florida State University has used the following comprehensive instrument to provide their student teachers with the opportunity to evaluate all areas of the student teaching experience. The areas evaluated by the instrument include: 1) the student teaching experience as a whole; 2) the supervising teacher; 3) the appropriateness of each school setting; 4) the quality and frequency of supervision provided by both the supervising teacher and the University supervisor; 5) the required reports and projects; and 6) the role of the coordinator and the Office of Field Experiences. Although F.S.U. student teachers complete the questionnaire in a confidential manner with only an identification of their county, school district, and subject area, the instrument can easily be adapted to secure even more specific information as desired.

The Mind Doctor

I see, her host said, nodding as if he had been listening to her when in fact he had been rehearsing what he wanted to say himself. Harry offered her, with a magnanimous gesture, anyone in the room as a character but three that absolutely belonged to him. It's only those three that interest me, she teased, noticing over Harry D. Gaulle's shoulder an oriental woman coming toward them with a bomb on a silver tray, the fuse lit. Harry, for God's sake, look out, Genevi?ve said. Why, he was saying, if you can have any of the really extraordinary people in this room, some of whom are more accomplished than my char acters, do you insist on running off pell mell with mine? The bomb went off just behind his ear. Genevi?ve threw herself toward the rug, wrenching her faith in human nature. I can t understand it, Fran?oise Gaulle said in a confidential manner to her guests. We always treated Doris like a member of the family. If Im not mistaken, she's even a moderately sympathetic character in one of my late husband's books. Harry D. Gaulle had always hungered for recognition, someone was saying in an authoritative voice?it was the cultural editor of the Paris edition of the Herald Tribune?was the first of his crowd to misperceive any given fashion. It was a function of his integrity, don't you know, to miss the point. The hostess had no choice under the circumstances but to reemploy the maid (good help in Paris hard to find that spring) to sweep up the remains of her late husband.