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PubMed1996

Integrating general practice and hospital services.

OBJECTIVES: To evaluate a model of negotiations between six Divisions of General Practice and four teaching hospitals, aimed at creating formal agreements to improve the GP-hospital interface. METHOD: The evaluation examined the model's outcomes and participants' experiences. Outcomes were investigated via unstructured interviews with key informants, and analysis of relevant documentation. Participants' experiences were elicited via structured interviews with 11 Divisional members and 14 hospital representatives. RESULTS: Progress towards agreements was made in all cases, with a full agreement being reached at one hospital. Negotiations are continuing in the remaining hospitals. Additional outcomes were achieved during the process, and included resources and structural arrangements involving GPs. Participants were satisfied with the model, but certain key issues were identified. CONCLUSION: This evaluation suggests that for negotiations between GPs and hospitals to be successful, Divisions must be involved and be representative, hospitals must see value in formal agreements, their structure must be considered and the process must be collaborative. In the current policy context, which emphasises primary care, hospitals and GPs are increasingly likely to start working more cooperatively. This model has significant potential to improve the interface between the two parties, through its formal negotiation process, and could easily be adapted to other settings.

Australia↗
PubMed2004

Genome-scale expression of proteins from Bacillus subtilis.

We have applied high throughput methods for cloning and expression of more than 850 genes from the Bacillus subtilis genome. The process uses 96-well plates and is automated from the level of primer design to the detection of soluble protein by a tag detection screen. This process was applied to a set of cytoplasmic targets from Bacillus subtilis to produce clones expressing soluble protein for incorporation into the structure determination pipeline of the Midwest Center for Structural Genomics. We also evaluated the feasibility of these plate-based methods for domain-based cloning and expression of secretory proteins and putative soluble domains of membrane proteins. This approach shows promise for implementation in a high throughput format and could provide additional target resources for structure determination. The continued development of new technologies that can be implemented in an automated format will be essential for continued success in the structural genomic programs.

Bacillus subtilis↗
PubMed2004

Protein expression arrays for proteomics.

As biology approaches the 50th year of deciphering the DNA code, the next frontier toward understanding cell function has protein biochemistry in the form of structural and functional proteomics. To accomplish the needs of proteomics, novel strategies must be devised to examine the gene products or proteins, emerged as en masse. The authors have developed a high-throughput system for the expression and purification of eukaryotic proteins to provide the resources for structural studies and protein functional analysis. The long-term objective is to overexpress and purify thousands of proteins encoded by the human genome. This library of proteins--the human proteome--can be arrayed in addressable format in quantities and purities suitable for high-throughput studies. Critical technology involved in efficiently moving from genome to proteome includes parallel sample handling, robust expression, and rapid purification procedures. Automation of these processes is essential for the production of thousands of recombinant proteins and the reduction of human error.

Animals↗
PubMed2004

[Evaluation of hospital resources for perinatal assistance in Brazil].

OBJECTIVE: To verify the adequacy of hospital resources for perinatal care in Belo Horizonte, MG, Brazil in 1996. METHODS: This is a cross-sectional study conducted encompassing all the 28 maternity-hospitals in the city of Belo Horizonte, capital of the State of Minas Gerais, Brazil. A model of evaluation denominated "Níveis de Complexidade e Segurança em Potencial de Unidades Perinatais de Hospitais-Maternidade" [Levels of Complexity and Potential Safety in Maternity-Hospitals]. This model is based on the evaluation of three major areas in the hospital: general structure, perinatal clinical infra-structure and resources available in perinatal units. Two scores involving these three areas were created. When evaluating low risk perinatal care, the score may sum to a total of 1,000 points. On the other hand, when high to medium perinatal risk care is considered, the score may sum to 2,000 points. Hosptals that scored more than 500 points were classified in two levels: I-A and I-B (for low risk); and six levels I-A through III-B (for medium/high risk). RESULTS: Five hospitals were classified as level 0 according to the low risk score, that is, they were not considered adequate to assist any delivery. When the medium/high risk score was employed, a total of seven hospitals were considered inadequate to assist any delivery. CONCLUSIONS: This evaluation model was capable of classifying hospitals according to available infra-structure for perinatal care.

Brazil↗
PubMed2005

A comparative study of six European databases of medically oriented Web resources.

OBJECTIVES: The paper describes six European medically oriented databases of Web resources, pertaining to five quality-controlled subject gateways, and compares their performance. METHOD: The characteristics, coverage, procedure for selecting Web resources, record structure, searching possibilities, and existence of user assistance were described for each database. Performance indicators for each database were obtained by means of searches carried out using the key words, "myocardial infarction." RESULTS: Most of the databases originated in the 1990s in an academic or library context and include all types of Web resources of an international nature. Five databases use Medical Subject Headings. The number of fields per record varies between three and nineteen. The language of the search interfaces is mostly English, and some of them allow searches in other languages. In some databases, the search can be extended to Pubmed. Organizing Medical Networked Information, Catalogue et Index des Sites Médicaux Francophones, and Diseases, Disorders and Related Topics produced the best results. CONCLUSIONS: The usefulness of these databases as quick reference resources is clear. In addition, their lack of content overlap means that, for the user, they complement each other. Their continued survival faces three challenges: the instability of the Internet, maintenance costs, and lack of use in spite of their potential usefulness.

Databases, Bibliographic↗
PubMedDate not supplied

A cell-centered database for electron tomographic data.

Electron tomography is providing a wealth of 3D structural data on biological components ranging from molecules to cells. We are developing a web-accessible database tailored to high-resolution cellular level structural and protein localization data derived from electron tomography. The Cell Centered Database or CCDB is built on an object-relational framework using Oracle 8i and is housed on a server at the San Diego Supercomputer Center at the University of California, San Diego. Data can be deposited and accessed via a web interface. Each volume reconstruction is stored with a full set of descriptors along with tilt images and any derived products such as segmented objects and animations. Tomographic data are supplemented by high-resolution light microscopic data in order to provide correlated data on higher-order cellular and tissue structure. Every object segmented from a reconstruction is included as a distinct entity in the database along with measurements such as volume, surface area, diameter, and length and amount of protein labeling, allowing the querying of image-specific attributes. Data sets obtained in response to a CCDB query are retrieved via the Storage Resource Broker, a data management system for transparent access to local and distributed data collections. The CCDB is designed to provide a resource for structural biologists and to make tomographic data sets available to the scientific community at large.

Animals↗
PubMed2002

Health sector reform and public sector health worker motivation: a conceptual framework.

Motivation in the work context can be defined as an individual's degree of willingness to exert and maintain an effort towards organizational goals. Health sector performance is critically dependent on worker motivation, with service quality, efficiency, and equity, all directly mediated by workers' willingness to apply themselves to their tasks. Resource availability and worker competence are essential but not sufficient to ensure desired worker performance. While financial incentives may be important determinants of worker motivation, they alone cannot and have not resolved all worker motivation problems. Worker motivation is a complex process and crosses many disciplinary boundaries, including economics, psychology, organizational development, human resource management, and sociology. This paper discusses the many layers of influences upon health worker motivation: the internal individual-level determinants, determinants that operate at organizational (work context) level, and determinants stemming from interactions with the broader societal culture. Worker motivation will be affected by health sector reforms which potentially affect organizational culture, reporting structures, human resource management, channels of accountability, types of interactions with clients and communities, etc. The conceptual model described in this paper clarifies ways in which worker motivation is influenced and how health sector reform can positively affect worker motivation. Among others, health sector policy makers can better facilitate goal congruence (between workers and the organizations they work for) and improved worker motivation by considering the following in their design and implementation of health sector reforms: addressing multiple channels for worker motivation, recognizing the importance of communication and leadership for reforms, identifying organizational and cultural values that might facilitate or impede implementation of reforms, and understanding that reforms may have differential impacts on various cadres of health workers.

Attitude of Health Personnel↗
PubMed2005

Quality of child health services in primary health care facilities in south-east Nigeria.

BACKGROUND: To assess the quality of child health services in primary health care (PHC) facilities in Calabar, south-east Nigeria. DESIGN: Cross-sectional, descriptive design. METHODS: Key informant interviews, structured observation, self-administered questionnaire and focus group discussion. SETTING: Calabar, south-east Nigeria. Participants All 10 PHC facilities in Calabar, 252 PHC workers serving in the facilities, and 76 mothers whose children received care in the facilities. OUTCOME MEASURES: Adequacy of structure (equipment and personnel); process (diagnosis, training and knowledge, use of national case-management algorithm, and supervision), and output (clients' satisfaction). MAIN RESULTS: PHC facilities were adequately equipped to the extent of providing immunization services and management of diarrhoea but not for other aspects of care expected of a PHC centre, including management of acute respiratory infections (ARI), a common problem in children in the region. Supply of essential drugs was inadequate in all centres and facilities for emergency care were lacking. Many of the health care workers (68.3%) had adequate training in immunization, and their knowledge scores on immunization issues (62%) was higher than in other aspect of PHC. Use of the national case management algorithm was low among PHC workers. Results of the focus group discussions with mothers showed that a few perceived quality of care to be poor. The main concerns were long waiting time, lack of essential drugs, and attitude of the health workers. CONCLUSIONS: Inadequacy in the quality of child health services in PHC facilities is a product of failures in a range of quality measures -- structural (lack of equipment and essential drugs), process failings (non-use of the national case management algorithm and lack of a protocol of systematic supervision of health workers). Efforts to improve the quality of child health services provided by PHC workers in the study setting and similar locales in less developed countries should focus not only on resource-intensive structural improvements, but also on cheap, cost-effective measures that address actual delivery of services (process), especially the proper use of national guidelines for case management, and meaningful supervision.

Acute Disease↗
PubMedDate not supplied

Rationing influenza vaccine: Legal strategies and considerations for local health officials.

Despite the fact that influenza vaccine is an important health resource, the structure and organization of the US vaccine manufacturing system has produced influenza vaccine shortages or distribution delays in five out of the last six influenza seasons. These shortages have produced the need for local public health officials to develop protocols for rationing and redistributing influenza vaccine at the local community level. In so doing, local health officials are confronted with significant practical and legal constraints associated with allocating a resource that is largely not under direct government control. In the face of an impending influenza vaccine shortage, local public health departments endeavor to do three things: (1) assess the local supply of vaccine, (2) assess the local demand from high-risk community members, and (3) ensure that to the greatest extent, the limited local supply of vaccine is used exclusively by those at highest risk within the local jurisdiction. There are a number of legal tools and strategies that local health officials have at their disposal to carry out these functions. This article will attempt to outline some of the significant legal impediments and practical constraints that local public health officials face in managing influenza vaccine supply-demand issues and will offer some suggestions for strengthening their ability to effectively manage these increasingly common situations.

Community Health Services↗
PubMed1998

Implementation of a quality system (ISO 9000 series) for placental blood banking.

Although placental blood has recently become a new source of hematopoietic progenitors for marrow replacement, limited attention has been given to systems suitable to ensure the short-term and long-term quality of placental blood units used for transplantation. In this article, we describe a quality system for placental blood banking developed in accord with ISO 9002 norms at Milano Cord Blood Bank. The quality system is the organizational structure, procedures, processes, and resources needed to implement quality management. ISO 9002 is a model for quality assurance in production, installation, and servicing, which includes a number of clauses providing guidance for the implementation of the quality system. The quality system was started by the bank medical director with step 1: the general quality plan, which included (a) the written description of mission, objectives, technical and organizational policies, and staff organization chart of the placental blood bank, (b) the definition and acquisition of adequate financial, human, and structural resources, (c) the appointment of a quality system head independent from the production laboratory and reporting directly to the medical director. Tasks of the quality system head were (a) to identify the placental blood banking process together with the placental blood bank personnel, (b) to implement a documentation plan finalized at the production and maintenance of (i) the quality manual, which provides a summary on how the bank operates with a quality system in compliance with the ISO 9002 clauses, (ii) the general procedures (or quality system procedures), which provide more detail on selected clauses, including at least those prescribed by the ISO 9002 standard, (iii) the operative procedures (or process procedures), which describe in detail the process of placental blood banking and how technical activities must be performed, (iv) the work instructions, which provide stepwise descriptions of individual activities, (v) records/forms for data collection and storage, (c) to identify quality indicators, (d) to start a regular internal audit, (e) to report audit results to the medical director for review. This was followed by step 2: the job descriptions, staff training, and qualification; step 3: the documentation plan; step 4: the internal audit plan; step 5: the launch of the quality system, and step 6: the assessment by an external team from an accredited third-party organization and final certification for compliance to ISO 9002. The quality system, which must be maintained and undergo external audit at regular intervals so that certification is confirmed, ensures the high probability that placental blood units provided to clinicians conform regularly to predefined levels of quality.

Blood Banks↗
PubMed1980

Processing resource demands of failure detection in dynamic systems.

The information-processing channels, proprioceptive versus visual, that are used to detect changes in the response of dynamic systems are investigated using a loading-task methodology. Conditions are compared in which subjects either control the dynamic system (MA mode) or monitor an autopilot controlling the same system (AU mode). Failure detection in these two modes of participation is evaluated when subjects perform the task alone and concurrently with either a tracking loading task or a mental arithmetic-memory loading task. The former task disrupted MA detection but not AU detection, whereas the converse results were obtained with the mental-arithmetic task. The results, interpreted within the framework of a structure-specific resource theory of human attention, suggest that AU detection relies exclusively on processing resources associated with perceptual/central-processing stages. MA detection in contrast relies on separate-processing resources residing in a response-related reservoir.

Automobile Driving↗
PubMed2006

Argument-predicate distance as a filter for enhancing precision in extracting predications on the genetic etiology of disease.

BACKGROUND: Genomic functional information is valuable for biomedical research. However, such information frequently needs to be extracted from the scientific literature and structured in order to be exploited by automatic systems. Natural language processing is increasingly used for this purpose although it inherently involves errors. A postprocessing strategy that selects relations most likely to be correct is proposed and evaluated on the output of SemGen, a system that extracts semantic predications on the etiology of genetic diseases. Based on the number of intervening phrases between an argument and its predicate, we defined a heuristic strategy to filter the extracted semantic relations according to their likelihood of being correct. We also applied this strategy to relations identified with co-occurrence processing. Finally, we exploited postprocessed SemGen predications to investigate the genetic basis of Parkinson's disease. RESULTS: The filtering procedure for increased precision is based on the intuition that arguments which occur close to their predicate are easier to identify than those at a distance. For example, if gene-gene relations are filtered for arguments at a distance of 1 phrase from the predicate, precision increases from 41.95% (baseline) to 70.75%. Since this proximity filtering is based on syntactic structure, applying it to the results of co-occurrence processing is useful, but not as effective as when applied to the output of natural language processing. In an effort to exploit SemGen predications on the etiology of disease after increasing precision with postprocessing, a gene list was derived from extracted information enhanced with postprocessing filtering and was automatically annotated with GFINDer, a Web application that dynamically retrieves functional and phenotypic information from structured biomolecular resources. Two of the genes in this list are likely relevant to Parkinson's disease but are not associated with this disease in several important databases on genetic disorders. CONCLUSION: Information based on the proximity postprocessing method we suggest is of sufficient quality to be profitably used for subsequent applications aimed at uncovering new biomedical knowledge. Although proximity filtering is only marginally effective for enhancing the precision of relations extracted with co-occurrence processing, it is likely to benefit methods based, even partially, on syntactic structure, regardless of the relation.

Genetic Diseases, Inborn↗
PubMedDate not supplied

[Census of the Italian Nephrology and Dialysis Units. Comparison between Lombardy and Piedmont].

The Italian Society of Nephrology promoted a national survey to obtain detailed information from all the Renal and/or Dialysis Units through an on-line questionnaire concerning structural, technological and human resources, as well as organisation characteristics and activities. The purpose of this initiative was to obtain regional reference benchmarks for each Nephrology Unit. In this paper we compare two northwestern Italian Regions: Lombardy and Piedmont. As far as epidemiology is concerned, the prevalence of dialysis patients is quite similar in the two Regions: for haemodialysis 616 pmp (patients per million population) in Lombardy and 595 in Piedmont, for peritoneal dialysis 104 pmp vs. 114 pmp, while the incidence of dialysis patients is 169 vs. 166 pmp. The gross mortality for dialysis patients is 12.4% vs. 13.7% and 0.9% vs. 2.0% in transplanted patients. The distribution of vascular access is also quite similar in the two Regions: prevalent arteriovenous fistula 83% vs. 74%, central venous catheter 11% vs. 18%, vascular grafts 7% vs. 8%. Structural resources: the hospital beds (49 pmp in the two Regions) and the dialysis places (161 vs. 166 pmp) do not differ between the two Regions. Personnel resources: physicians 37 pmp in Lombardy and 44 pmp in Piedmont, renal nurses 167 pmp vs. 186, respectively. Activity: hospital admission 1722 pmp vs. 1507 pmp, renal biopsies 131 pmp vs. 109 pmp. Although the two regions examined are numerically different, both have a high standard of quality, making Italy a model of nephrology organisation. This initiative to take a census of the Italian Nephrology and Dialysis Units provides an interesting tool to describe the present status of the operational structures, to identify precise benchmarking values, at both the regional and national level, and to act as a prelude for further rationalization and growth of the nephrology network in Italy.

Ambulatory Care Facilities↗
PubMed2000

Federalism, entitlements, and discretionary grants: the fiscal context of national support for immunization programs.

This paper defines the appropriation and resource allocation structure of federal government programs that deliver vaccines to the public through state and local governments, with a special focus on the Centers for Disease Control and Prevention (CDC) Section 317 program. The paper places these programs in the context of the overall intergovernmental finance system of the United States, and the manner in which that system has responded to societal changes in other areas, such as unemployment insurance and environmental protection. The paper concludes that a changing environment for vaccine financing, and uncertain appropriations for state government immunization infrastructure, may have made the current CDC Section 317 program inadequate. Increased entitlement resources for federally funded vaccines have not been matched with increased and stable resources for the balance of program costs. To the contrary, funding provided to the Section 317 program has proven unstable, and its discretionary appropriations have proven vulnerable to both executive and legislative branch earmarking for such activities as overseas disease eradication or home state earmarking by congressional appropriations subcommittee members. In addition, the rigidity of some CDC program requirements makes it difficult for states to effectively use program funds. Consideration should be given to strengthening the Section 317 program and its relationships to other federal aid programs to ensure that adequate immunization protections are provided in all states to adequately protect all citizens.

Centers for Disease Control and Prevention, U.S.↗
PubMed1998

A quality system for placental blood banking.

A Quality System for Placental Blood Banking aimed at the transplantation of haematopoietic stem cells to related and unrelated allogeneic recipients is described. It includes the organizational structure, procedures, processes and resources needed to implement quality management. The Quality System described in this article is based on ISO 9002, a model for quality assurance in production, installation and servicing developed in 1987 and revised in 1994 by the International Organization for Standardization. ISO 9002 includes 20 clauses that provide guidance for the implementation of the Quality System. The development of the Quality System is started by the Placental Blood Bank Medical Director with the definition of a General Quality Plan including: (1) the written description of the Mission, Objectives, Technical and Organizational Policies, and Staff Organization Chart; (2) the definition and acquisition of adequate financial, human and structural resources; (3) the appointment of a Quality System Head, who must identify the Placental Blood Banking process together with the Placental Blood Bank personnel; implement a documentation plan; identify quality indicators; start regular internal audit; report audit results to the Medical Director for review. Following staff training and qualification, the Quality System is launched. The Placental Blood Bank can then undergo audit by an external inspector and be finally certified for compliance to ISO 9002. The Quality System must be maintained and subjected to external audit at regular intervals so that certification is confirmed.

Blood Banks↗
PubMedDate not supplied

[Criteria for the evaluation of environmental hygiene].

The process of rationalizing resources brought the health care institutions and hospitals to let out some services, including the cleaning and sanitation services. In order to write the tender the hospital had to specify both the expected standard of service (i.e. what should be cleaned, how, how many times etc) and the evaluation criteria. The experiences of two community hospitals (Vigevano and Garbagnate) are presented, focusing on the method and criteria they adopted. In both experiences the head nurses were the main responsible for the definition of the criteria, the forms and the process of evaluation. Garbagnate hospital gave priority to outcome criteria (i.e. lack of dust on surfaces, lack of spots on heaters etc.). The 84 criteria identified were divided as follows: 7 criteria for the structure and resources, 6 for the process and 71 for the outcome, with a yes-no-not applicable evaluation. The focus of the other hospital was on process criteria (to be assessed on a 5 points Likert scale, from absent to 100% compliance) and on the knowledge-educational level of the personnel responsible for the cleaning.

Environmental Health↗
PubMed1999

Quality-assessed reviews of health care interventions and the database of abstracts of reviews of effectiveness (DARE). NHS CRD Review, Dissemination, and Information Teams.

OBJECTIVES: Database of Abstracts of Reviews of Effectiveness (DARE) (http:@www.york.ac.uk/inst/crd/) at the NHS Centre for Reviews and Dissemination provides a unique international resource of structured summaries of quality-assessed reviews of health care interventions. These reviews have been identified from searches of electronic databases and by hand-searching journals. This paper describes and summarizes the DARE database, including the topic areas covered and the review methods used. METHODS: The first 480 structured abstracts on the DARE database were summarized. Data were extracted from each database field and coded for analysis. RESULTS: Most of the systematic reviews investigated the effectiveness of treatments: 54% investigated the effectiveness of medical therapies, and 10% assessed surgical interventions. Around two-thirds used meta-analytic methods to combine primary studies. The quality of the reviews was variable, with just over half of the reviews (52%, n = 251) having systematically assessed the validity of the included primary studies. Narrative reviews were more likely than meta-analyses to reach negative conclusions (42% vs. 25%, p = .0001). The 21 reviews that reported drug company funding were more likely to reach positive conclusions (81% vs. 66%, p = .15). CONCLUSION: The DARE database is a valuable source of quality-assessed systematic reviews, and is free and easily accessible. It provides a valuable online resource to help in filtering out poorer quality reviews when assessing the effectiveness of health technologies.

Abstracting and Indexing↗
PubMed2004

Presumptive coding. A preliminary study of the aggregation of input diagnoses to determine their relevance to clinical governance and urological resourcing.

OBJECTIVE: To determine the validity of a system for coding the reason for urological referral from primary care, using ICD10, and thus enable benchmarking of urological outpatient activity. PATIENTS AND METHODS: Four studies were conducted: (i) A pilot study to aggregate information into a few input diagnosis codes (925 patients); (ii) Validation of the aggregated codes using input diagnoses from a second centre (928 patients); (iii) A prospective study by three urologists to determine the system's generic utility (918 patients); (iv) A study to aggregate the presumptive codes for 2771 patients to gain an insight into the case-mix of patients referred to a general urological service via the outpatient department. RESULTS: The aggregation of input diagnoses from general practice referrals into 36 'presumptive codes' was possible and could be validated. Prospective coding, for 96% of eligible patients, was possible with < 1% of referral diagnoses not being codable. Further aggregation of the data for 2771 patients showed that 31% were referred with urological malignancy whilst 69% had symptoms suggesting benign urological disease. CONCLUSIONS: This preliminary study of presumptive coding suggests that it is a feasible and valid method of recording the input diagnoses for patients presented to a urological service. The information it provides has relevance for the structuring, benchmarking, resourcing and manpower requirements of that service, essential components for clinical governance. It also has relevance to the prospective collection of patient data for research and audit.

England↗