Daily Care Information System Requirements: Professional Service-Driven Service Blueprint Approach.

BACKGROUND: Long-term care (LTC) services are a professional service-driven (PSD) system; to deliver appropriate care services to residents, health care providers first need to collect appropriate patient data and make a professional assessment. A well-designed LTC information system should therefore consider the information requirements of multidisciplinary health care providers to adequately support their care services. OBJECTIVES: This study proposed a modified service blueprint-the PSD service blueprint-for visualizing interdisciplinary service providers' input and output information requirements, which correspond to their service activities. METHODS: The PSD service blueprint comprises five layers and seven elements. We also present a case study to illustrate the blueprint's application to daily LTC services. RESULTS: Our proposed approach could clearly illustrate the daily care activities, service providers (main actors), actors' input and output information, and suggestions for LTC information system-related applications. CONCLUSION: The proposed PSD service blueprint can not only gather interdisciplinary LTC service providers' information system requirements but also act as a mapping tool for visualizing the care service process.

Educational Intervention on Undergraduate Cancer Awareness and Self-Directed Learning.

Traditional lecture-based learning (LBL) can increase cancer awareness in undergraduates. However, because of the rapidly changing knowledge base in medicine, undergraduates must develop skills required for lifelong self-directed learning (SDL). Problem-based learning (PBL) has been suggested as an SDL approach. This study used a nonequivalent control group with a pretest-posttest design for comparing PBL and LBL for their effectiveness in increasing cancer awareness and SDL among nonmedicine or nonnursing major undergraduates in a health-related general education course. Experimental groups 1 and 2 were instructed using PBL while the control group was instructed using LBL. Cancer educational programs were offered to experimental group 1 and the control group but not to experimental group 2. Among the 325 undergraduates who completed a questionnaire regarding cancer awareness and SDL in the pretest, 223 completed the 12-week follow-up survey of the posttest. Cancer awareness significantly improved between the pretest and posttest in the control group (P < 0.001). No significant difference in cancer awareness improvement was observed between experimental group 1 and the control group (P = 0.934). Cancer awareness improvement in experimental group 2 was significantly less than in the control group (P = 0.010). No statistically significant change in SDL was observed in the control group during the study (P = 0.897). However, the SDL of experimental groups 1 and 2 improved more significantly than that of the control group (P = 0.049 and 0.023, respectively). Therefore, PBL is an effective method of increasing cancer awareness and SDL in undergraduates.

Effects of argument quality, source credibility and self-reported diabetes knowledge on message attitudes: an experiment using diabetes related messages.

BACKGROUND: Previous studies have reported that credibility and content (argument quality) are the most critical factors affecting the quality of health information and its acceptance and use; however, this causal relationship merits further investigation in the context of health education. Moreover, message recipients' prior knowledge may moderate these relationships. OBJECTIVES: This study used the elaboration likelihood model to determine the main effects of argument quality, source credibility and the moderating effect of self-reported diabetes knowledge on message attitudes. METHODS: A between-subjects experimental design using an educational message concerning diabetes for manipulation was applied to validate the effects empirically. A total of 181 participants without diabetes were recruited from the Department of Health, Taipei City Government. Four group messages were manipulated in terms of argument quality (high and low) × source credibility (high and low). RESULTS: Argument quality and source credibility of health information significantly influenced the attitude of message recipients. The participants with high self-reported knowledge participants exhibited significant disapproval for messages with low argument quality. CONCLUSION: Effective health information should provide objective descriptions and cite reliable sources; in addition, it should provide accurate, customised messages for recipients who have high background knowledge level and ability to discern message quality.

Cancer awareness changes after an educational intervention among undergraduate students.

The objectives of this study are to assess undergraduate awareness of cancer risk factors, prevention strategies, and warning signs and to evaluate whether an educational intervention increases cancer awareness. This study adopts a nonequivalent control group pretest-posttest design. Of the 386 students who completed the pretest, only 35-39 % identified low fruit and vegetable intake, being overweight, and physical inactivity as cancer risk factors, and <30 % recognized persistent changes in bowel or bladder habits and persistent cough or hoarseness as cancer warning signs. After the educational intervention, the analysis of variance of changes from baseline (the pretest score) for all four experimental groups were all significantly higher than those of the two control groups (p ≤.001), except for the change of the retention test score from the pretest score for experimental group 3. This study highlights the need to improve undergraduates' cancer awareness and the effectiveness of educational intervention.

Changes in stroke awareness among undergraduate students after an educational intervention.

OBJECTIVE: This study investigated undergraduates'awareness about stroke, the effects of an educational intervention and the difference of measuring tests between recognition and recall. METHODS: We chose a convenient sample from two classes. One of the classes, the recognition group, was tested by a close-ended questionnaire with multiple choices. The other class, the recall group, was tested via an open-ended questionnaire. Participants completed their pretest and first posttest before and right after the education intervention. Twelve weeks after the intervention, participants were tested again to assess the knowledge retention over time. RESULTS: Fifty six participants in the recognition group and 53 participants in the recall group completed all three tests. Before the intervention, all respondents in the recognition group could recognize three or more risk factors and at least one warning sign, but in the recall group were only 32% and 72% respectively. After the intervention, the mean scores of first posttest and second posttest were all significant higher than that of pretest in both groups (P less 0.001). Comparisons of mean score of same items in both groups, the mean score of recognition group was significantly higher than that of recall group at each test (all P less 0.001). CONCLUSION: The intervention improved participants'knowledge towards stroke, even twelve weeks later. Participants obtained higher scores with a close-ended questionnaire than those with an open-ended questionnaire.

Laparoscopic radical hysterectomy using pulsed bipolar system: comparison with conventional bipolar electrosurgery.

OBJECTIVE: To compare the efficacy, results and complications of using the pulsed bipolar system (PlasmaKinetic; Gyrus Medical, Maple Grove, MN) and conventional bipolar electrosurgery (Kleppinger bipolar forceps; Richard Wolf Instruments, Vernon Hills, IL) in laparoscopic radical hysterectomy and pelvic lymphadenectomy in the management of early invasive cervical carcinoma. METHODS: This was a retrospective case-control study. We recruited consecutively 38 patients with cervical cancer for laparoscopic radical hysterectomy with pulsed bipolar system. For comparison, we recruited consecutively the latest 38 patients with cervical cancer for laparoscopic radical hysterectomy with conventional bipolar electrosurgery in the same period. From Jan. 2001 to Dec. 2005, total 76 patients with cervical cancer for laparoscopic radical hysterectomy were recruited for statistical analysis. RESULTS: No significant difference was found between the two groups in terms of age, body weight, staging, and hospital stay. There were statistically significant difference in blood loss and operative time. The blood loss was more in conventional bipolar electrosurgery group (mean 564 ml, median 500 ml, range 50-2400 ml) compared with pulsed bipolar system group (mean 397 ml, median 350 ml, range 100-1200 ml) (p<0.03). But there was no statistically significant difference in blood transfusion between the two groups (p=0.454). The operation time for the conventional bipolar electrosurgery group (mean 229 min, median 232 min, range 121-352 min) was longer than that for the pulsed bipolar system group (mean 172 min, median 177 min, range 65-267 min) (p<0.001). None of the laparoscopic procedure was required to be converted to laparotomy. There was no significant difference in the intra-operative complication, but there was statistically less postoperative complication in the pulsed bipolar system group (p<0.01). There was no significant difference in recurrence rate in both groups. CONCLUSIONS: Our findings indicate that pulsed bipolar system is more effective in laparoscopic radical hysterectomy when compared with conventional bipolar electrosurgery. Pulsed bipolar system has advantage over conventional bipolar electrosurgery in less blood loss, shorter operative time, less postoperative complication and may offer an alternative option for patients undergoing laparoscopic radical hysterectomy.

A new approach for laparoscopic ovarian transposition before pelvic irradiation.

OBJECTIVE: To evaluate and describe our special design of laparoscopic ovarian transposition to a high anterolateral position using Lee-Huang point as first entrance and landmark before pelvic irradiation in premenopausal patients with a gynecologic malignancy. METHODS: Laparoscopic surgery was conducted to transpose bilateral ovaries in consecutive cases of premenopausal women with a gynecologic malignancy requiring pelvic irradiation in a university-based, tertiary-level training center for endoscopic surgery. Ovaries were transposed to a high anterolateral position, 3-4 cm above umbilical line. RESULTS: Laparoscopic ovarian transpositions were performed bilaterally in consecutive fourteen cases without conversion to laparotomy. The mean operating time was 128 min (range, 83-181 min) and average blood loss was 74 mL (range, 10-150 mL). No intraoperative or immediate postoperative complication related to the laparoscopic ovarian transposition procedure was observed. The mean follow-up period was 72 months (range, 42-142 months) and only one of the seven (14.29%) patients under 39 years old became ovarian failure after receiving concurrent chemoradiation. CONCLUSION: The new designed method of laparoscopic ovarian transposition is a simple and safe procedure. We recommend this process to premenopausal women who required pelvic irradiation, especially for those less than 40 years old.

Concomitant pelvic organ prolapse surgery with TVT procedure.

The aim of this study is to evaluate the efficacy and feasibility of concomitant pelvic reconstructive surgery with tension-free vaginal tape (TVT) procedure to treat pelvic organ prolapse women with urodynamic stress incontinence (USI) or occult USI. Seventy-five women with pelvic organ prolapse and diagnosed as USI or occult USI were enrolled in this study. All patients with USI or occult USI underwent TVT treatment under general anesthesia, combined with transvaginal total hysterectomy (VTH), anterior-posterior colporrhaphy (APC), and/or right sacrospinous ligament suspension (SSS) reconstructive surgeries. The subjective assessment was evaluated by using a visual analog scale (VAS) score and a urinary symptomatic questionnaire. The objective assessment was carried out with a 1-h pad test, cough stress test, and urodynamic examination. Of the 75 patients, 35 patients with grade III uterine prolapse underwent VTH and APC, 30 patients with grade IV uterine prolapse underwent VTH, SSS, and APC, and the other 10 patients who had previous hysterectomy with total vaginal vault prolapse underwent SSS and APC. The mean follow-up interval was 25 months (12-42 months). The mean hospitalization was 5.9 days and the mean catheterization time was 3.8 days. The subjective success rate for the treatment of urine incontinence was 88%, and the objective complete cure rate was 84%. The rate of postoperative complications with persistent urinary urgency, de novo detrusor overactivity, dysfunctional voiding, and tape erosion were 50, 8, 12, and 1.3%, respectively. There were no bladder perforations during the TVT procedure and no perioperative complications requiring conversion to laparotomy. Pelvic organ prolapse women with USI or occult USI can be treated by reconstructive surgeries combined with a TVT procedure to treat and prevent postoperative USI.