bluuebunny/crossref_metadata_2025 huggingface dataset:
Punishment, border crossings and the powers of horror
Authors: Valier Claire
Published: April 2009

Gothicism, typified by gruesome injury and trauma, and menacing shadowy figures, is a prominent feature of the discourses of public protection and vengeful punishment. Historically the gothic has dramatized a modern preoccupation with boundaries and their collapse. Today an increasingly complex series of networks and flows cross, undermine and remake the borders and boundaries of old. Important contemporary reconfigurations include the erosion of traditional distinctions between public and private spheres, between information and entertainment and between legal and extra-legal. Understanding this profusion of different kinds of border crossings requires the scholar to depart from the Eliasian equation of interdependencies with a ‘civilizing process’ associated with restraint, sympathy and tolerance. To understand the complexity of border crossings, experimentation is required with concepts that directly theorize the breaching of established spatial entities and categories, and that focus attention on the potent effects of flows, new connections and the in-between. One such concept is the notion of abjection, through which the powers of horror invoked by popular cultural representations, case law and penal practices are related to the horror of that which breaches borders. This article contributes an exploration of the visceral passions of contemporary penality in terms of Julia Kristeva’s assertion that, ‘according to the logic of separation, it is flow that is impure’.
The strengths and limits of ‘doing gender’ for understanding street crime
Authors: Miller Jody
Published: April 2009

This paper is an engagement with Messerschmidt’s structured action theory, and more generally with feminist criminologists’ applications of the concept ‘doing gender’ for understanding street crime. Specifically, I investigate the ways in which the attribution of gender difference and the near exclusive emphasis on normative practices has limited our use of the doing gender model in theorizing gender and crime. I discuss several avenues for enhancing this approach, including the imperative to avoid tautology, and suggestions for challenging gender dualism, investigating the import of social hierarchies, and conceptualizing the complexities of agency and social practice.
Rebellion Beyond the Classroom:
Authors: HAGAN JOHN , PARKER PATRICIA
Published: April 2009

A life-course capitalization theory of intergenerational causes of delinquency proposes that educational disinvestment is a core adolescent source of disadvantage on to which ensuing adult and parenting problems are grafted. This theory is supported by findings from an intergenerational panel study revealing that a prospective parent's educational disinvestment as an adolescent, in the form of low educational aspirations and educational underachievement, leads to dropping out of school, teen parenthood, unemployment, and marriage and parenting problems, all of which contribute cumulatively to the intergenerational causation of delinquency among children and adolescents. Main and interactive effects of parental unemployment are apparent in this model, providing a clearer picture of how class is linked to the intergenerational causation of delinquency. Parental self-reported delinquency and police contacts in adolescence do not have intergenerational effects. These null effects may reflect the minor form of commonly reported delinquencies. Rytina's life chances' methodology is used to summarize our intergenerational life-course capitalization model.
Producing Feminist Knowledge:
Authors: COMACK ELIZABETH
Published: April 2009

In responding to the androcentrism of mainstream epistemologies, feminists have confronted the broader issues around how we can produce knowledge which will be helpful to women. In particular, the work of standpoint feminists—while focusing our attention on creating knowledge `for' women—has been subject to the critical gaze of postmodern writers like Carol Smart. This article endeavors to add another voice to these deliberations. Informed by the experience of doing research with women in prison, I propose that by problematizing the differing conceptions of `standpoint,' specifically, the `women's standpoint' and the `feminist standpoint,' we can better address the issues raised by postmodernists.
Social Crime Revisited
Authors: LEA JOHN
Published: April 2009

This article attempts a critical re-evaluation of the concept of social crime. A brief review of the deployment of the concept by radical historians in studies of crime in 18th-century England is followed by an analysis of attempts to apply the term to crime in modern industrial capitalism. The article concludes with an attempt to rehabilitate the concept as useful in the present context in particular as a counterbalance to an overemphasis on the victim perspective in contemporary critical criminologies.
A Consideration of Gender in Relation to Social Learning and Social Structure: A General Theory of Crime and Deviance
Authors: MORASH MERRY
Published: April 2009

This article considers Ronald Akers' book, Social Learning and Social Structure: A General Theory of Crime and Deviance, in relation to knowledge about crimes against women and the relationship of gender to type, pattern and amount of crime. Contributions of the book are summarized, and shortcomings discussed. Specific criticisms are lack of integration with feminist theory in the areas of conceptualizing and measuring crime and deviance and a failure to consider gender structure. The final discussion focuses on implications for theory development.
You Are What You Listen To: Young People's Stereotypes about Music Fans
Authors: Rentfrow Peter J. , McDonald Jennifer A. , Oldmeadow Julian A.
Published: April 2009

Research suggests that young people use music to express themselves and to make claims about their identities. The current work considered the possible consequences of using music in this way. Using a sample of 80 British young adults, we aimed to replicate and extend previous research on the stereotypes that young people have about fans of various musical genres. It was hypothesized that individuals attribute similar psychological characteristics and social categories to fans of certain styles of music and that those distinct associations are generalizable. Results indicated that judges agreed on both the psychological (personality, personal qualities and values) and social (ethnicity and social class) characteristics of music fans, that the content of the music-genre stereotypes varied between genres, and that the stereotypes are geographically robust. The implications of this work for group processes and intergroup relations are discussed.
Blame It on Hip-Hop: Anti-Rap Attitudes as a Proxy for Prejudice
Authors: Reyna Christine , Brandt Mark , Tendayi Viki G.
Published: April 2009

This research investigated the stereotypes associated with rap music and hip-hop culture, and how those stereotypes may influence anti-Black attitudes and justifications for discrimination. In three studies—using a representative sample from America, as well as samples from two different countries—we found that negative stereotypes about rap are pervasive and have powerful consequences. In all three samples, negative attitudes toward rap were associated with various measures of negative stereotypes of Blacks that blamed Blacks for their economic plights (via stereotypes of laziness). Anti-rap attitudes were also associated with discrimination against Blacks, through both personal and political behaviors. In both American samples, the link between anti-rap attitudes and discrimination was partially or fully mediated by stereotypes that convey Blacks' responsibility. This legitimizing pattern was not found in the UK sample, suggesting that anti-rap attitudes are used to reinforce beliefs that Blacks do not deserve social benefits in American society, but may not be used as legitimizing beliefs in other cultures.
The Impact of Music on Automatically Activated Attitudes: Flamenco and Gypsy People
Authors: Rodríguez-Bailón Rosa , Ruiz Josefa , Moya Miguel
Published: April 2009

The two studies reported in this article agree in demonstrating that activating a positive side of the stereotype of a traditionally prejudiced group could be a useful strategy to improve the implicit attitude toward that group. The goal of the current research was to explore whether activating the present association between Flamenco music and Gypsy people would decrease the negative view of this group in Spain, using the IAT measure. In the first study, when a stereotype-consistent but positive feature of Gypsies (i.e. Flamenco music) was used as a positively valued attribute in the IAT measure, the IAT effect was lower than when a different positive stimulus was used (classical music clips). The findings of Study 2 showed that for the North African community—another highly discriminated group in Spain—the use of Flamenco or classical music clips did not have any effect on the implicit attitudes of participants toward them. The implications for attitudes toward discriminated groups and the use of music to improve intergroup relationships are discussed.
The Dynamic of Songs in Intergroup Conflict and Proximity: The Case of the Israeli Disengagement from the Gaza Strip
Authors: Bensimon Moshe
Published: April 2009

This study explores intergroup dynamics through group singing during the Israeli disengagement from the Gaza Strip. Interviews with 14 protesters and 14 security force members showed how different genres of songs affected intergroup conflict or proximity. When protesters sang Israeli folk songs, rhythmic Jewish religious songs and protest songs, these songs evoked negative feelings among security force members, thus increasing intergroup conflict. When protesters expressed pain and sadness through singing slow, quiet, spiritual songs, these songs evoked empathy on the part of security force members, thus increasing intergroup proximity. This dynamic is discussed in the light of socio-psychological studies and the emotional influences of music.
But who will make the visits? A patient-related information system for management in district nursing
Authors: Goldstone L. A. , Wing S. , Barker L. , Hughes A.
Published: April 2009

District nurses in Barnsley, UK, have for many years used a patient classification system based on ‘Criteria for Care’, whose value in practical management terms has established itself into the routine of the information system used. This is a descendant of FIP, now known as TCCS (Total Care Community System). ‘Criteria for Care’ was, however, hospital based and an independent validity check was required for community use. This was carried out in Belfast, Northern Ireland, where research produced a system for patient classification, workload analysis and skillmix analysis which was generated by nurses and acted both as a validity check and further development of the system used in Barnsley.

The management information matrix, which is the outcome of this paper, is generated from practitioners using guidelines agreed by them, and yields management information of a directly practical value.

The system presented is now implemented and uses data updated daily, if required, to produce a spreadsheet covering team workload index, a workload profile, and measures of pressure of work on each nurse, patient acuity [1], and a quality of care index. From this it is possible to adjust skillmix and staffing levels to create equity of pressure across teams and to match nursing skillmix to patient classification in the light of a quality index from each team.

From a GP attachment and a team perspective this information can be utilized in conjunction with contract monitoring data in order to review district nursing activity. This will enable workloads to be reviewed and could facilitate integrated team working within the practice.
EHR and EPR confidentiality based on accountability and consent: tools for the Caldicott Guardian
Authors: Longstaff J. J. , Capper G. , Lockyer M. A. , Thick M. G.
Published: April 2009

The primary care-based electronic health record (EHR) and the electronic patient record (EPR) are key features of the UK National Health Service (NHS) Information Strategy. We propose a model for EHR/EPR confidentiality - that is, for restricting access to their contents to authorized users, assuming secure transmission of data. We summarize a UML model for EHR/EPR confidentiality which is consistent with the NHS Healthcare Model. A prototype implementation of the model based on OODB and Internet techniques is described. The work is intended as a contribution to the development of confidentiality systems for the EHR and EPR, and also of computerized tools for Caldicott Guardians to specify and implement privacy policies and procedures.
Building bridges: constructing a framework for evidence-based information systems
Authors: Atkins C. , Louw G.
Published: April 2009

A recurring and problematic characteristic of information systems’ (IS) use has been the development of isolated ‘islands of information’. As technological advances have provided solutions, so, however, have the original problems been transformed. The current archipelago exists largely unrecognized, partly because the matter from which the islands are formed has also changed. It is no longer the content of the computerized systems that is isolated but information about IS practice itself. Academic research, practitioner reports and vendor marketing all contribute to a disparate collection of contradictory and often unevaluated information concerning IS practice, while the large volume of this information and the ease of its accessibility serve to disguise the extent of its fragmentation.

Following the lead established by medicine and healthcare, the creation of an ‘evidence-based’ culture within the IS community, particularly the creation of systematic analyses of relevant literature, has been proposed as one means of bridging the gaps between these islands. There are, however, significant differences between IS and healthcare which need to be recognized if the transfer of concepts is to be successful. In this paper we identify and describe some of those differences and provide an initial sketch of a framework in which an evidence-based IS culture could flourish.
Practice nurses’ training in information technology: report on an empirical investigation
Authors: Russell A. , Alpay L.
Published: April 2009

Information technology (IT) is an integral part of the development and delivery of health services. Healthcare professionals, including nurses, are in need of appropriate educational training to enable them to use IT adequately. In particular, nurses in primary care have had less access to IT training and fewer opportunities to benefit from IT. Furthermore, little evidence is found in the literature on the current situation of IT training needs and requirements for nurses in primary care.

This paper discusses critical issues in the training of primary care nurses in information technology. It then reports on the PRACTIS (PRimary care nurses Access to Communications Technology and Informatics Skills) project which is addressing these issues through an empirical investigation. Preliminary results are examined. Finally, directions for further work in the training of primary care nurses are also discussed.
What determines GPs’ use of a clinical decision support software system: an analysis from Prodigy Phase II
Authors: Bojke C. , Nestor G.
Published: April 2009

The substantive aim of this research was to identify the factors which affected GPs’ use of the decision support software PRODIGY (Prescribing RatiOnally with Decision support In General practice studY) during the second trial phase of its evaluation. The methodological aim of the paper is to show how problems of multi-collinearity, self-selection and unobserved factors, which typically arise in observational studies, were overcome via a combination of study design and application of the correct statistical procedures. The exercise finds that GP and practice-specific factors, as well as guideline factors, have a significant role in determining the individual GP’s use of PRODIGY.
The impact of the Internet on the doctor-patient relationship
Authors: Nwosu C. R. , Cox B. M.
Published: April 2009

This paper presents the results of a study of 300 randomly selected obstetricians and gynaecologists in the United Kingdom to assess their perception of the effect of Internet usage by patients on the doctor-patient relationship. It also considers their perception of the extent of patients’ Internet usage, the quality of the information on the Internet and the need for Internet access and training in hospitals. Results showed that respondents accepted that the Internet might lead to patients being better informed than themselves with 40 per cent feeling that this may damage the doctor-patient relationship. Despite this 90 per cent believed that providing more and better information to patients was good. Respondents were aware that patients used the Internet for medical information but felt that their own patients’ usage was low and that the quality of information was variable. Use of the Internet was thought to be beneficial for patients but could confuse them, leading to unrealistic expectations and increased medical litigation. Most respondents think all doctors should be Internet trained, but only a minority had training programmes in their hospitals. Respondents want Internet training to be more widely available.
System issues for successful telemedicine implementation
Authors: Fitch C. J. , Briggs J. S. , Beresford R. A.
Published: April 2009

Although there is a great deal of activity in the area of telemedicine in the United Kingdom, it has not yet been widely adopted as a tool for healthcare delivery. This could partly be as a result of the fact that the various parties involved in the development of such projects come from different backgrounds and disciplines and as such do not always fully understand the aspects involved in the successful implementation of such projects.

This may lead to projects not working as expected or being abandoned prematurely. This paper examines some common issues relating to telemedicine projects in greater detail. The rapid development of technology may sometimes overshadow the organizational and societal aspects of telemedicine applications but systems are likely to fail or not fully perform as anticipated if issues are not properly considered.

The paper aims to provide a comprehensive, although not exhaustive, summary of some of the matters involved. It raises a number of questions in an attempt to increase awareness of all parties, so perhaps aiding the wider, successful implementation of telemedicine systems.
Education, training and the development of healthcare informatics
Authors: Norris A. C. , Brittain J. M.
Published: April 2009

Since the mid-1980s, there has been an enormous investment in information technology and information systems in the health sector. The return on this investment has been comparatively poor and many systems have failed to live up to their promise. A major cause of the poor performance is the lack of an equivalent investment in the education and training needed for all aspects of information systems development, implementation and operation. This paper considers the nature of healthcare information and traces the emergence of the discipline of healthcare informatics, a discipline which attempts to provide the necessary foundation for appropriate education and training in the use of information by healthcare professionals. The paper also discusses the content and delivery of healthcare informatics courses and the relationship between the academic and health-care sectors. Finally, it outlines the roles of international collaboration and professional recognition in advancing the field of healthcare informatics and its application to high-quality and cost-effective healthcare.
Validation of a theoretical model linking organizational fit and diffusion of innovation in information systems development
Authors: Gladwin J. , Wilson T. D.
Published: April 2009

Exploratory, inductive analysis has not validated the linking of diffusion of innovation and dynamic equilibrium frameworks by grounding these theories in empirical information systems development. This paper reports on an ethnographic case study that followed the introduction of new health information management strategies in a low-income country. The aim was not to test theory, but to use existing theory to develop an interpretation of the themes and patterns which arose. During the analysis this research empirically validated the idea of organizational fit and concepts from the diffusion of innovation theoretical framework.

Some refinements to the models and several contributions to theory have been made. In addition many implications for practice are identified. Furthermore, because theory can have an impact upon the way planners frame problems and identify solutions, this combination of theoretical frameworks could bring benefits to future IS development and organizational change.
An extranet architecture for inter-operability among healthcare systems
Authors: Landers D. , Buckley M. , Roantree M.
Published: April 2009

Most federations of healthcare systems have operated in an in-house environment where local area networks coupled with layers of interoperability were used to connect various information systems. More recently, a need has arisen to connect large institutions such as hospitals, with wider area applications such as general practice systems in order to create the complete patient record. In this paper we present a model and architecture, which addresses the problem of connecting all parties involved in patient healthcare.
Methods for troubleshooting a video before assessing its clinical impact
Authors: Wright P. , Belt S.
Published: April 2009

No techniques have been established for assessing quality or troubleshooting video materials before evaluating their clinical effectiveness - for example in a randomized controlled trial (RCT). This paper reports three studies leading to the development of such techniques. In the first study 20 adults rated successive video clips for informativeness and style giving separate ratings for visual presentation and spoken commentary. Pooling across raters yielded a profile of the high and low points within the video. The profile for the first video was replicated across two participant groups, each of 20 adults. This profiling technique identified potential trouble-spots within an HRT video and potential repairs were assessed in Study 2 where the rating procedure was changed to a pairwise comparison, enabling revisions to be evaluated against original clips by another 24 adults. The outcome of this comparison was validated in Study 3 using the full profiling procedure and substituting the revised clips for the originals. These studies show that the quick and simple rating techniques developed in Studies 1 and 2 offer ways of checking the micro-quality of a video and identifying potential trouble-spots. This enables weaknesses to be removed before the effectiveness of the video is evaluated in a clinical context.
Health informatics and the cultural divide: a UK perspective
Authors: McPherson S. , Wilkinson M.
Published: April 2009

This paper discusses the concerns about the growing ‘digital divide’ within society which has implications for maintaining both health and social inequalities in the UK. The main focus of the paper is about inequalities in health relating to culture and ethnicity. Different theoretical approaches to cultural differences in health are set out as well as different ways of classifying cultural and ethnic differences in health service research. The argument then goes on to suggest that the emphasis on cultural and ethnic categorization only further divides people and fails to reduce inequalities. Transculturalism is defined and set out as a more useful way of approaching cultural difference as it is less restrictive and prescriptive. The paper sets out how this approach can be used to develop better quality health content in health informatics that is useful and relevant to a wider range of users, thus tackling both the digital divide and health inequalities.a
An informaticist working in primary care: a descriptive study
Authors: Martin P. , Kauser A.
Published: April 2009

A regional R and D grant was used to explore how an informaticist could stimulate and respond to questioning behaviour in primary care clinicians. Training needs for the informaticist were identified and provided for. Nurses and doctors working in primary care were approached individually. They were encouraged to think about their clinical behaviour and to identify topics where they thought they might like to have more evidence either to justify their current practice or to stimulate change.

The personal approach was labour intensive but seemed to provide a good yield in questions. The project took two years and the informaticists have tackled over 125 topics. The project is being evaluated by the Department of Primary Care at University College Hospital Medical School, London. A number of the GPs who used the service were interviewed and there was a high level of satisfaction. There was some informal feedback that the answers to the questions actually changed clinical behaviour but so far, audits of reported changes have not been carried out. Funding to continue and expand the service has now been secured through the access to evidence initiatives.
User acceptance of inter-organizational electronic medical records
Authors: Handy J. , Hunter I. , Whiddett R.
Published: April 2009

This paper reports the findings of the first stage of an ongoing, longitudinal study into primary care practitioners’ views of an electronic medical records (EMR) system for maternity patients. All doctors and midwives holding maternity care contracts with a large urban hospital in New Zealand were sent a questionnaire soliciting their views on a planned EMR system linking the hospital and the primary care sectors.

The questionnaire was based on Davis’ technology acceptance model (TAM) [1]. The results show that while Davis’ two key factors of perceived ease of use and perceived usefulness were important to medical professionals, other features of the proposed system and the wider organizational environment also influenced the respondents’ willingness to utilize the proposed system.
Information overload: implications for healthcare services
Authors: Wilson T. D.
Published: April 2009

Information overload is not a new phenomenon: the potential for it has existed ever since information became an important input to any human activity. For example, once the scientific disciplines began to clearly emerge in the seventeenth to the nineteenth centuries, it gradually became impossible for anyone to keep abreast of all of the work in what had been called ‘natural philosophy’. In some fields, the degree of specialization is so high that, even within the same discipline, people are unable to keep abreast of all subareas and, in fact, may be completely unable to understand some of them. This paper defines and analyses the phenomenon of information overload and seeks to present organizational therapies that address it.
Error estimation in linking heterogeneous data sources
Authors: Monga H. K. , Patrick T. B.
Published: April 2009

There are many instances in an institution when there is a need to gather data from different departments. Record linkage is the technique used to bring together these separately compiled records into a useful format. Unfortunately, even with perfect data, error may be introduced when records from different sources are linked. We assume then, that at least for large-scale day-to-day operations, no data collection or repository produced by linking records from different sources should be declared error free. Thus, for quality assurance purposes, it will be useful to have methods that may be applied in day-to-day operations for estimating error produced by linking records. In this paper we describe our attempts to estimate the false negative error rate in record linkage serving periodic quality reporting.
User acceptance of a multi-media software application to increase preparedness for caring problems
Authors: Chambers M. , Connor S. L. , McGarvey H. , Diver M.
Published: April 2009

This paper presents verification data for a multimedia software application intended to enhance carers’ ability to respond to everyday difficulties and emergency situations. The program provides educational information about first aid, how to deal with everyday problems and a number of emergency situations such as bleeding, falling and choking. An evaluation plan was developed, including instruments for measuring and assessing usability. These included a questionnaire, scenarios and a pro-forma for user trials; a questionnaire for evaluation of the program; log diaries, field notes and technical diaries. User trials were carried out with both healthcare professionals and family carers. Casual users were encouraged to test the programs at the professional sites. Users’ views on usability were utilized for the development of further prototype of the software application.
The role of information technology in the explication and crystallization of tacit healthcare knowledge
Authors: Cheah Y. -N. , Abidi S. S. R.
Published: April 2009

As a major contributor and user of healthcare knowledge, the healthcare enterprise requires intelligent knowledge management strategies to effectively exploit expert-quality healthcare knowledge. In this paper, we discuss a novel knowledge acquisition and representation strategy using healthcare scenarios. This strategy is complemented with an ontology- or thesaurus-based input standardization mechanism to limit the diverse nature of the healthcare experts’ input. We also present in detail an algorithm for healthcare knowledge crystallization that, in addition to simulating the process of annealing, employs the notion of nucleation and growth on healthcare knowledge. The crystallized knowledge potentially undergoes a repair process that employs analogical reasoning to identify less useful knowledge and transform them, with the aid of more established knowledge, into useful ones. We conclude by asserting that the strategies presented do provide an all-rounded approach in our efforts to bring quality healthcare knowledge and services to the masses.
The electronic medical record and everyday medical work
Authors: Clarke K. M. , Hartswood M. J. , Procter R. N. , Rouncefield M.
Published: April 2009

The deployment of the electronic medical record (EMR) is widely seen by healthcare policy makers and service managers as a key step in the achievement of more efficient and integrated healthcare services. However, our studies of medical work practices reveal important discrepancies between the presumptions of EMR and the ways in which healthcare professionals actually use and communicate information. These lead us to conclude it may be some time before technologies like the EMR can deliver promised benefits, and will do so only if they are allowed to evolve via user-led design and development processes.
Information empowered health consciousness
Authors: Ginman M. , Eriksson-Backa K.
Published: April 2009

This paper presents the results of a pilot study conducted to test the methods of a more extended survey. The aim of the pilot study was to examine how the connection between existing knowledge and received health information could be studied, as well as to find out if there are differences in the health knowledge and health behaviour of individuals living in different information cultures. Nine students at Åbo Akademi University undertook three tests, and the authors found three different groups of people according to their source behaviour. These were ‘the Doctors’ group’, consisting of people preferring information from formal medical expertise; ‘the Documentary group’, using popular science sources; and ‘the News group’, living in the daily world of mass media. Of these groups only the ‘Documentary group’ was seriously interested in health information and the people in this group were also the best and most widely informed on health issues. The results show that there are major differences in health knowledge and behaviour among individuals living in different information milieus.
Health information on the Internet in Lithuania
Authors: Maceviciute E. , Klusovskiene R.
Published: April 2009

The paper deals with the evaluation of Lithuanian health information resources on the Internet. The aim is to introduce initial findings regarding the development of usage and creation of electronic health information resources in Lithuania and the statistical overview of Lithuanian health information sites on the Internet. The methods used were: analysis of documentation and literature; interviews with the persons who create health information resources and work at implementing of health information programmes; and survey of existing Lithuanian health information sites on the Internet. Lithuanian health information resources on the WWW have become a part of the Internet health information resources worldwide. There is also a sufficient infrastructure for continuing the development of this particular field. Besides, the medical professionals have become aware and sensitive of the issue of the Internet usage and its potentials for the professional needs as well as for the patients and public in general. The lack of an overall information strategy for healthcare is one of the problems that should be addressed by the government officials and leaders of the medical profession as soon as possible.
Impact analysis in virtual outreach information services (VIVOS project)
Authors: Urquhart C. , Yeoman A. , Cooper J. , Tyler A.
Published: April 2009

The aim of the VIVOS project was to develop and evaluate methodologies, that is, sets of methods, for determining the value and impact of ‘virtual outreach’ information services, in the health sector. Five different projects were recruited initially, with another two added later. Around 150 interviews were conducted, with additional postal questionnaire surveys. Preliminary findings are discussed in relation to policy initiatives for clinical governance and improved patient information. Conclusions suggest that design of information service support is necessary.
FUNAGES: an expert system for fundus fluorescein angiography
Authors: Dimitroula V. , Bassiliades N. , Vlahavas I. , Dimitrakos S.
Published: April 2009

FUNAGES is an expert system that deals with the interpretation of fundus fluorescein angiography. Fluorescein angiography is an extremely valuable clinical test that provides information about the circulatory system of the ocular fundus (the back of the eye) not attainable by routine examination. The different appearance of fluorescein, in place and time and the classification of the fundus diseases render angiography a dynamic, cinematographic and deductive diagnostic method. Therefore, ability to interpret fundus fluorescein angiograms allows an ophthalmologist specializing in ocular fundus diseases to follow a systematic, orderly and logical line of reasoning that leads to a proper diagnosis. FUNAGES was developed to simulate such logical reasoning, in order to train inexperienced ophthalmologists in the interpretation of angiograms. The system achieved its purpose via a graphical user interface and a thorough knowledge base.
Deploying quality management in trusted third parties within a medical environment: towards ISO9000 compliance
Authors: Lekkas D. , Gritzalis S. , Katsikas S.
Published: April 2009

In this paper we present a complete reference framework for the operation of a Trusted Third Party (TTP) as an organization within a medical environment. The objective is to form an intermediate reference model, to which the TTPs will conform, towards the full compliance to the ISO-9000 quality standard. There are two dimensions of quality in respect of a TTP, which are related to specific medical environment issues: the first quality dimension regards the value-added security services and products it provides, which must fulfil the user requirements and be characterized by efficiency, reliability, security, credibility and trust. The second quality dimension refers to the internal organization, which must maximize its effectiveness by achieving efficient management, have a clear and strict structure and comply with the registered internal procedures. The guidelines for achieving the above mentioned quality objectives are reflected within the published Quality Policy Statement and the Certification Practice Statement (CPS).
h-Life: an intelligent personal health assistant
Authors: Nanou D. G. , Poulis A. M. , Likas A. , Fotiadis D. I.
Published: April 2009

In this paper the architecture and subsystems of the h-Life platform are described. The system is currently under implementation and therefore all system components and modules are described according to their design specifications. h-Life aims at developing a user-friendly, personalized and ubiquitously accessible knowledge-based system that will provide citizens with an intelligent tool for monitoring the state of health and lifestyle. The h-Life system is based on the integration of several components: • a knowledge repository related to health, nutrition, fitness and lifestyle• a user repository where personal health records and user profiles are stored• a plan repository for the storage of medical plans• an intelligent adviser and plan selection mechanism, which provides advice and plans based on the user profile• an alerting and reminding module that issues alerts (to ensure the timely execution of a selected plan) and notifications concerning events of potential interest• a customer-facing module, which ensures personalized interaction with the system and customizes the user-system interaction according to the user profile.Based on the latest technology in intelligent and communication systems, the h-Life environment aims at providing the user with personalized, ‘certified’ lifestyle information and consultancy, tailored to individual needs and available anywhere and at anytime.
Variation in EPR clinical support systems: data, decisions and disparity
Authors: Lorence D. P. , Spink A. , Jameson R.
Published: April 2009

In an evidence-based healthcare environment, the quality of electronic patient record (EPR) data maintained on clinical support systems becomes a critical factor in the decision making process, with a corresponding need for error management through automated data quality assurance practices. This paper reports on a study, the objective of which was to examine and compare adoption rates of EPR data reliability within clinical support systems, and associated regional variation across the US. Data were collected by mail and telephone surveys nationwide across the US. The participants in the surveys were all accredited US health information managers. The outcome measure was reported levels of automated data edit methodologies in electronic patient records. Findings suggest inconsistent adoption of automated data quality management in electronic patient records. This low overall adoption of automated edits was accompanied by significant variation across geographic regions and key organizational variables. The authors concluded that utilization of EPR data in evidence-based medical decision making must be undertaken with caution, especially when outcomes or other decision support data are compared across states or regions.
Programmable electronic medical systems – related risks and learning from accidents
Authors: Koornneef F. , Voges U.
Published: April 2009

The application of medical devices is often combined with some risk. This risk needs to be evaluated and compared with the benefits: based on this, evaluation of the device needs to fulfil a certain safety integrity level.

On the basis of examples of failures of medical systems, some measures to overcome repetitive failures and to diminish their negative effects will be described. The use of a reporting procedure and a reporting system should help early recognition and removal of faults. Learning from incidents must be organized and users, producers and licensing bodies need to be involved. The design of medical devices needs to take careful consideration of the possible risks involved with the use of the devices, especially in the case of sophisticated devices and their use by inexperienced laypersons. The identification of user requirements, relevant application contexts and the associated assignment of the appropriate risk category are discussed.
The technology prescription: linking telecare and informatics by using a need-led paradigm
Authors: Levy S. , Bradley D. A. , Swanston M. T.
Published: April 2009

This paper summarizes a current study examining the availability, appropriateness and acceptability of a technologically dependable healthcare provision to both service users and staff. An interface between the Electronic Patient Record (EPR) and future home care technology (Telecare) is suggested in the form of a ‘technology prescription’. It is argued that appropriately prescribed technology will enable people to benefit from a modern, evidence-based service, which promotes a proactive means of addressing and preventing future health and care needs. The paper argues that technological innovations in care must not be perceived as a threat to the partnerships necessary in achieving maximum health gains, but rather be an aid to a patient centred clinical encounter.
Towards security in multi-agency clinical information services
Authors: Aljareh S. , Rossiter N.
Published: April 2009

There is no doubt that the privacy of individuals, the confidentiality of information about them, the integrity of transaction holding and the availability of service systems are all essential; threats in any one of these aspects is costly and could lead to disaster. Securing computer services has been considered a core part of any new development, one of which is clinical information systems. In this paper we discuss a security policy model for a clinical information system and investigate whether logical languages can represent the principles of this kind of model. We have used three logical security languages: the Authorization Specification Language (ASL), a Language for Security Constraints on Objects (LaSCO) and Ponder: a Language for Specifying Security and Management Policies for Distributed Systems. We will also study whether these principles are sufficient to deal with the case of multi-agency services and sharing information with different agencies such as social services, police and education authority.
Designing dependable assistive technology systems for vulnerable people
Authors: Dewsbury G. A. , Taylor B. J. , Edge H. M.
Published: April 2009

Designing assistive technological solutions for disabled and older people is fraught with problems because of the number of agencies involved. These problems are compounded by the lack of under-standing that can exist between the engineers and the health staff. This lack of understanding can develop into extreme delays in installing the technology, while the needs of the person with disabilities are subsumed in preference to ease of design and installation. Clearly, these potential misunderstandings could be ameliorated by improved communication between the widely different disciplines each with their own culture, ethos, knowledge and jargon. The CUSTODIAN Smart-House simulation software provides a focus for discussion on CUSTODIAN's development in relation to reliability and safety of systems design.
Access-rule certificates for secure distributed healthcare applications over the Internet
Authors: Mavridis I. , Georgiadis C. , Pangalos G.
Published: April 2009

Access control in medical information systems distributed over the Internet is an important issue directly related to the protection of patients’ privacy. It is therefore essential to satisfy the increasing demand for exploiting Internet mechanisms in order to achieve a secure health information network. This can only be done, however, if it can be guaranteed that appropriate measures have been taken to preserve a satisfactory level of security for the information concerned. Recent efforts in this direction rely on public-key cryptography and digital certificates. Identity certificates are suitable for identification and authentication purposes. In addition, attribute certificates are another type of certificate particularly suitable for authorization purposes. In order to fully exploit digital certificates to protect distributed healthcare applications over the Internet, we propose the use of a third type of certificate, called access-rule certificates, which are useful for the enforcement of global access-control mechanisms between different organizations. In this paper, we present the structure of those three types of certificate, as well as the access-control procedures when using them; we describe the architecture of the proposed system whose purpose is to explore the use of certificates for the implementation of a suitable security policy for healthcare environments.
Readmissions - can they be predicted on admission?
Authors: Allgar V. , Procter S. , Pearson P. , Lock C. , Taylor G. , Wilcockson J. , Foster D. , Spendiff A.
Published: April 2009

This paper looks at the development of logistic regression models to predict readmissions for medical patients on their initial admission to hospital. The design of our study was a retrospective analysis of a large dataset drawn from a range of secondary sources - medical, nursing, therapy and social care records. Three northern hospitals and related community health districts and social care organizations in the UK participated. Records of 1,192 patients discharged from medical wards during the period April 1992-March 1995 were analysed. Readmission within six weeks of discharge was the main outcome measure.Four logistic regression equations were produced. Three individual site equations were calculated and classification levels for readmission of 17-22 per cent were achieved. Component factors that differed in importance were age, GP contact, social services contact, marital status and living status. The weakest equation was the equation that encompassed patients from all three sites, which classified 7 per cent of readmissions. It is possible to develop equations that will explain readmission for a fifth of medical patients on admission to individual hospitals. Further exploratory work needs to be undertaken to explore reasons for differences between districts and develop more generalizable predictive equations.
Designing an information interface to support sharing of information in cancer care
Authors: Allam O. , Gray W. A. , Jones W. , Bater A. , Morrey D.
Published: April 2009

This paper describes the design, implementation and testing of a functional prototype interface which enables primary healthcare teams to access the information system supporting clinical oncology specialists in South Wales, UK. A lack of information sharing has been recognized for some time as a barrier to improving the primary care of cancer patients. This extension to the existing ISCO information system will allow sharing of information about patient management at all levels of cancer patient support (general practitioners, hospital-based clinicians and palliative care teams). The application was designed to allow general practitioners to gain access to the existing system. This will give all healthcare professionals interested in a cancer patient's care the advantage of accessing detailed multiple providers' electronic casenotes in almost real time, thus improving communication of information within a care team. However, no attempt was made to include the much bigger issue of patients and their families or carers in the scope of the project at this stage, as this is an area requiring separate investigation. The pilot also enables general practitioners to determine the information they require and the information they need to be able to communicate with the cancer specialists.