273 resultados para Medical services
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Tracking/remote monitoring systems using GNSS are a proven method to enhance the safety and security of personnel and vehicles carrying precious or hazardous cargo. While GNSS tracking appears to mitigate some of these threats, if not adequately secured, it can be a double-edged sword allowing adversaries to obtain sensitive shipment and vehicle position data to better coordinate their attacks, and to provide a false sense of security to monitoring centers. Tracking systems must be designed with the ability to perform route-compliance and thwart attacks ranging from low-level attacks such as the cutting of antenna cables to medium and high-level attacks involving radio jamming and signal / data-level simulation, especially where the goods transported have a potentially high value to terrorists. This paper discusses the use of GNSS in critical tracking applications, addressing the mitigation of GNSS security issues, augmentation systems and communication systems in order to provide highly robust and survivable tracking systems.
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This paper describes a secure framework for tracking applications that use the Galileo signal authentication services. First a number of limitations that affect the trust of critical tracking applications, even in presence of authenticated GNSS signals, are detailed. Requirements for secure tracking are then introduced; detailing how the integrity characteristics of the Galileo authentication could enhance the security of active tracking applications. This paper concludes with a discussion of our existing tracking technology using a Siemens TC45 GSM/GPRS module and future development utilizing our previously proposed trusted GNSS receiver.
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The paper describes a number of requirements for enhancing the trust of location acquisition from Satellite Navigation Systems, particularly for those applications where the location is monitored through a remote GNSS receiver. We discuss how the trust of a location acquisition could be propagated to an application through the use of a proposed tamper-resistant GNSS receiver which quantifies the trust of a location solution from the signaling used (ie. P(Y) code, Galileo SOL, PRS, CS) and provides a cryptographic proof of this to a remote application. The tamper-resistance state of the receiver is also included in this cryptographic proof.
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Background: Patterns of diagnosis and management for men diagnosed with prostate cancer in Queensland, Australia, have not yet been systematically documented and so assumptions of equity are untested. This longitudinal study investigates the association between prostate cancer diagnostic and treatment outcomes and key area-level characteristics and individual-level demographic, clinical and psychosocial factors.---------- Methods/Design: A total of 1064 men diagnosed with prostate cancer between February 2005 and July 2007 were recruited through hospital-based urology outpatient clinics and private practices in the centres of Brisbane, Townsville and Mackay (82% of those referred). Additional clinical and diagnostic information for all 6609 men diagnosed with prostate cancer in Queensland during the study period was obtained via the population-based Queensland Cancer Registry. Respondent data are collected using telephone and self-administered questionnaires at pre-treatment and at 2 months, 6 months, 12 months, 24 months, 36 months, 48 months and 60 months post-treatment. Assessments include demographics, medical history, patterns of care, disease and treatment characteristics together with outcomes associated with prostate cancer, as well as information about quality of life and psychological adjustment. Complementary detailed treatment information is abstracted from participants’ medical records held in hospitals and private treatment facilities and collated with health service utilisation data obtained from Medicare Australia. Information about the characteristics of geographical areas is being obtained from data custodians such as the Australian Bureau of Statistics. Geo-coding and spatial technology will be used to calculate road travel distances from patients’ residences to treatment centres. Analyses will be conducted using standard statistical methods along with multilevel regression models including individual and area-level components.---------- Conclusions: Information about the diagnostic and treatment patterns of men diagnosed with prostate cancer is crucial for rational planning and development of health delivery and supportive care services to ensure equitable access to health services, regardless of geographical location and individual characteristics. This study is a secondary outcome of the randomised controlled trial registered with the Australian New Zealand Clinical Trials Registry (ACTRN12607000233426)
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Most information retrieval (IR) models treat the presence of a term within a document as an indication that the document is somehow "about" that term, they do not take into account when a term might be explicitly negated. Medical data, by its nature, contains a high frequency of negated terms - e.g. "review of systems showed no chest pain or shortness of breath". This papers presents a study of the effects of negation on information retrieval. We present a number of experiments to determine whether negation has a significant negative affect on IR performance and whether language models that take negation into account might improve performance. We use a collection of real medical records as our test corpus. Our findings are that negation has some affect on system performance, but this will likely be confined to domains such as medical data where negation is prevalent.
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Introduction The Australian Nurse Practitioner Project (AUSPRAC) was initiated to examine the introduction of nurse practitioners into the Australian health service environment. The nurse practitioner concept was introduced to Australia over two decades ago and has been evolving since. Today, however, the scope of practice, role and educational preparation of nurse practitioners is well defined (Gardner et al, 2006). Amendments to specific pre-existing legislation at a State level have permitted nurse practitioners to perform additional activities including some once in the domain of the medical profession. In the Australian Capital Territory, for example 13 diverse Acts and Regulations required amendments and three new Acts were established (ACT Health, 2006). Nurse practitioners are now legally authorized to diagnose, treat, refer and prescribe medications in all Australian states and territories. These extended practices differentiate nurse practitioners from other advanced practice roles in nursing (Gardner, Chang & Duffield, 2007). There are, however, obstacles for nurse practitioners wishing to use these extended practices. Restrictive access to Medicare funding via the Medicare Benefit Scheme (MBS) and the Pharmaceutical Benefit Scheme (PBS) limit the scope of nurse practitioner service in the private health sector and community settings. A recent survey of Australian nurse practitioners (n=202) found that two-thirds of respondents (66%) stated that lack of legislative support limited their practice. Specifically, 78% stated that lack of a Medicare provider number was ‘extremely limiting’ to their practice and 71% stated that no access to the PBS was ‘extremely limiting’ to their practice (Gardner et al, in press). Changes to Commonwealth legislation is needed to enable nurse practitioners to prescribe medication so that patients have access to PBS subsidies where they exist; currently patients with scripts which originated from nurse practitioners must pay in full for these prescriptions filled outside public hospitals. This report presents findings from a sub-study of Phase Two of AUSPRAC. Phase Two was designed to enable investigation of the process and activities of nurse practitioner service. Process measurements of nurse practitioner services are valuable to healthcare organisations and service providers (Middleton, 2007). Processes of practice can be evaluated through clinical audit, however as Middleton cautions, no direct relationship between these processes and patient outcomes can be assumed.
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Pediatric oncology has emerged as one of the great medical success stories of the last 4 decades. The cure rate of childhood cancer has increased from approximately 25% in the 1960’s to more than 75% in more recent years. However, very little is known about how children actually experience the diagnosis and treatment of their illness. A total of 9 families in which a child was diagnosed with cancer were interviewed twice over a 12-month period. Using the qualitative methodology of interpretative phenomenological analysis (IPA), children’s experiences of being patients with a diagnosis of cancer were explicated. The results revealed 5 significant themes: the experience of illness, the upside of being sick, refocusing on what is important, acquiring a new perspective, and the experience of returning to wellbeing. Changes over time were noted because children’s experiences’ were often pertinent to the stage of treatment the child had reached. These results revealed rich and intimate information about a sensitive issue with implications for understanding child development and medical and psychosocial treatment.
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Though web services offer unique opportunities for the design of new business processes, the assessment of the potential impact of Web services on existing business information systems is often reduced to technical aspects. This paper proposes a four-phase methodology which facilitates the evaluation of the potential use of Web services on business information systems both from a technical and from a strategic viewpoint. It is based on business process models, which are used to frame the adoption and deployment of Web services and to assess their impact on existing business processes. The application of this methodology is described using a procurement scenario.
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Web services are software components designed to support interoperable machine-to-machine interactions over a network, through the exchange of SOAP messages. Since the underlying technology is independent of any specific programming language, Web Services can be effectively used to interconnect business processes across different organizations. However, a standard way of representing such interconnections has not yet emerged and is the subject of an ongoing debate.
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In a competitive environment, companies continuously innovate to offer superior services at lower costs. ‘Shared Services’ have been extensively adopted in practice as a means for improving organizational performance. Shared Services are considered most appropriate for support functions and are widely adopted in human resource management, finance and accounting, and more recently employed as an information systems (IS) function. As computer-based corporate information systems have become de facto and the backbone of administrative systems, the technical impediments to sharing have come down dramatically. As this trend continues, CIOs and IT professionals need a deeper understanding of the Shared Services phenomenon. Yet, analysis of IS academic literature reveals that Shared Services, though mentioned in more than 100 articles, has received little in depth attention. This paper investigates the current status of Shared Services in IS literature. The authors present a detailed review of literature from main IS journals and conferences. The paper concludes with a tentative operational definition, a list of perceived main objectives of Shared Services, and an agenda for related future research.
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The travel and hospitality industry is one which relies especially crucially on word of mouth, both at the level of overall destinations (Australia, Queensland, Brisbane) and at the level of travellers’ individual choices of hotels, restaurants, sights during their trips. The provision of such word-of-mouth information has been revolutionised over the past decade by the rise of community-based Websites which allow their users to share information about their past and future trips and advise one another on what to do or what to avoid during their travels. Indeed, the impact of such user-generated reviews, ratings, and recommendations sites has been such that established commercial travel advisory publishers such as Lonely Planet have experienced a pronounced downturn in sales ¬– unless they have managed to develop their own ways of incorporating user feedback and contributions into their publications. This report examines the overall significance of ratings and recommendation sites to the travel industry, and explores the community, structural, and business models of a selection of relevant ratings and recommendations sites. We identify a range of approaches which are appropriate to the respective target markets and business aims of these organisations, and conclude that there remain significant opportunities for further operators especially if they aim to cater for communities which are not yet appropriately served by specific existing sites. Additionally, we also point to the increasing importance of connecting stand-alone ratings and recommendations sites with general social media spaces like Facebook, Twitter, and LinkedIn, and of providing mobile interfaces which enable users to provide updates and ratings directly from the locations they happen to be visiting. In this report, we profile the following sites: * TripAdvisor, the international market leader for travel ratings and recommendations sites, with a membership of some 11 million users; * IgoUgo, the other leading site in this field, which aims to distinguish itself from the market leader by emphasising the quality of its content; * Zagat, a long-established publisher of restaurant guides which has translated its crowdsourcing model from the offline to the online world; * Lonely Planet’s Thorn Tree site, which attempts to respond to the rise of these travel communities by similarly harnessing user-generated content; * Stayz, which attempts to enhance its accommodation search and booking services by incorporating ratings and reviews functionality; and * BigVillage, an Australian-based site attempting to cater for a particularly discerning niche of travellers; * Dopplr, which connects travel and social networking in a bid to pursue the lucrative market of frequent and business travellers; * Foursquare, which builds on its mobile application to generate a steady stream of ‘check-ins’ and recommendations for hospitality and other services around the world; * Suite 101, which uses a revenue-sharing model to encourage freelance writers to contribute travel writing (amongst other genres of writing); * Yelp, the global leader in general user-generated product review and recommendation services. In combination, these profiles provide an overview of current developments in the travel ratings and recommendations space (and beyond), and offer an outlook for further possibilities. While no doubt affected by the global financial downturn and the reduction in travel that it has caused, travel ratings and recommendations remain important – perhaps even more so if a reduction in disposable income has resulted in consumers becoming more critical and discerning. The aggregated word of mouth from many tens of thousands of travellers which these sites provide certainly has a substantial influence on their users. Using these sites to research travel options has now become an activity which has spread well beyond the digirati. The same is true also for many other consumer industries, especially where there is a significant variety of different products available – and so, this report may also be read as a case study whose findings are able to be translated, mutatis mutandis, to purchasing decisions from household goods through consumer electronics to automobiles.
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Background--The admission and assessment of patients for elective procedures is a task faced by all healthcare organisations that provide elective surgical services. Several different strategies have been used to facilitate the management of these tasks. Nurse-led preadmission clinics or services have been implemented in many health services as one of these management strategies; however their effectiveness has not been established. Objectives--The objective of this review was to examine the available research on the effectiveness of nurse-led elective surgery preoperative assessment clinics or services on patient outcomes.--Results--Of the 19 included articles, there were 10 audits of patient and hospital data, 3 surveys or questionnaires, 3 descriptive studies, 1 action research design, 1 prospective observational study and 1 RCT. Five of ten studies reporting data on cancellations rates found that nurse-led preadmission services reduced the number of day-of-surgery cancellations. Non-attendance for surgery was also reduced, with nine studies reporting decreases in the number of patients failing to attend. Eight studies reporting data on patient or parent satisfaction found high levels of satisfaction with nurse-led preadmission services. Three of four studies investigating the effect of the nurse-led preadmission service on patient anxiety found a reduction in reported anxiety levels. Three studies found that preoperative preparation was enhanced by the use of a nurse-led preadmission service.--Conclusions--While all included studies reported evidence of effectiveness for nurse-led preadmission services on a wide range of outcomes for elective surgery patients, the lack of experimental trials means that the level of evidence is low, and further research is needed.--Implications for practice--Nurse-led preadmission services may be an effective strategy for reducing procedural cancellations, failure to attend for procedures, and patient anxiety, however currently the evidence level is low.
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Objective--To determine whether heart failure with preserved systolic function (HFPSF) has different natural history from left ventricular systolic dysfunction (LVSD). Design and setting--A retrospective analysis of 10 years of data (for patients admitted between 1 July 1994 and 30 June 2004, and with a study census date of 30 June 2005) routinely collected as part of clinical practice in a large tertiary referral hospital.Main outcome measures-- Sociodemographic characteristics, diagnostic features, comorbid conditions, pharmacotherapies, readmission rates and survival.Results--Of the 2961 patients admitted with chronic heart failure, 753 had echocardiograms available for this analysis. Of these, 189 (25%) had normal left ventricular size and systolic function. In comparison to patients with LVSD, those with HFPSF were more often female (62.4% v 38.5%; P = 0.001), had less social support, and were more likely to live in nursing homes (17.9% v 7.6%; P < 0.001), and had a greater prevalence of renal impairment (86.7% v 6.2%; P = 0.004), anaemia (34.3% v 6.3%; P = 0.013) and atrial fibrillation (51.3% v 47.1%; P = 0.008), but significantly less ischaemic heart disease (53.4% v 81.2%; P = 0.001). Patients with HFPSF were less likely to be prescribed an angiotensin-converting enzyme inhibitor (61.9% v 72.5%; P = 0.008); carvedilol was used more frequently in LVSD (1.5% v 8.8%; P < 0.001). Readmission rates were higher in the HFPSF group (median, 2 v 1.5 admissions; P = 0.032), particularly for malignancy (4.2% v 1.8%; P < 0.001) and anaemia (3.9% v 2.3%; P < 0.001). Both groups had the same poor survival rate (P = 0.912). Conclusions--Patients with HFPSF were predominantly older women with less social support and higher readmission rates for associated comorbid illnesses. We therefore propose that reduced survival in HFPSF may relate more to comorbid conditions than suboptimal cardiac management.
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BACKGROUND: Indigenous patients with acute coronary syndromes represent a high-risk group. There are however few contemporary datasets addressing differences in the presentation and management of Indigenous and non-Indigenous patients with chest pain. METHODS: The Heart Protection Project, is a multicentre retrospective audit of consecutive medical records from patients presenting with chest pain. Patients were identified as Indigenous or non-Indigenous, and time to presentation and cardiac investigations as well as rates of cardiac investigations and procedures were compared between the two groups. RESULTS: Of the 2380 patients included, 199 (8.4%) identified as Indigenous, and 2174 (91.6%) as non-Indigenous. Indigenous patients were younger, had higher rates hyperlipidaemia, diabetes, smoking, known coronary artery disease and a lower rate of prior PCI; and were significantly less likely to have private health insurance, be admitted to an interventional facility or to have a cardiologist as primary physician. Following adjustment for difference in baseline characteristics, Indigenous patients had comparable rates of cardiac investigations and delay times to presentation and investigations. CONCLUSIONS: Although the Indigenous population was identified as a high-risk group, in this analysis of selected Australian hospitals there were no significant differences in treatment or management of Indigenous patients in comparison to non-Indigenous.
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The number of Australian children requiring foster care due to abuse and neglect is increasing at a faster rate than suitable carers can be recruited. Currently increased numbers of foster children are presenting with higher care needs. Evidence suggests carers with a higher education could contribute to placement stability and ultimately provide more positive outcomes for this group of children. This paper explores the level of interest by tertiary educated persons toward a model of fostering for children with higher needs. Using a descriptive survey methodology, a convenience sample of 644 university undergraduate and postgraduate students within faculties of health sciences, and education, arts and social sciences was employed. Psychology students in the 17-26 year old age group showed greatest interest in a professional foster care model and this was statistically significant (p=0.002 955 CI .000-.010) when compared to other health professionals and other age groups. Education students held the highest interest in general fostering although not statistically significant. When these survey results were extrapolated to the total number of health professionals in Australia there could be 8,385 potential recruits for a model professional foster care. Focused campaigns are required to source professional as recruits to fostering with the benefit of servicing the placement needs of higher care needs children and contributing to general foster care resources.