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PubMed2000

The exchange of radiotherapy data as part of an electronic patient-referral system.

PURPOSE: To describe the implementation and use of an electronic patient-referral system as an aid to the efficient referral of patients to a remote and specialized treatment center. METHODS AND MATERIALS: A system for the exchange of radiotherapy data between different commercial planning systems and a specially developed planning system for proton therapy has been developed through the use of the PAPYRUS diagnostic image standard as an intermediate format. To ensure the cooperation of the different TPS manufacturers, the number of data sets defined for transfer has been restricted to the three core data sets of CT, VOIs, and three-dimensional dose distributions. As a complement to the exchange of data, network-wide application-sharing (video-conferencing) technologies have been adopted to provide methods for the interactive discussion and assessment of treatments plans with one or more partner clinics. RESULTS: Through the use of evaluation plans based on the exchanged data, referring clinics can accurately assess the advantages offered by proton therapy on a patient-by-patient basis, while the practicality or otherwise of the proposed treatments can simultaneously be assessed by the proton therapy center. Such a system, along with the interactive capabilities provided by video-conferencing methods, has been found to be an efficient solution to the problem of patient assessment and selection at a specialized treatment center, and is a necessary first step toward the full electronic integration of such centers with their remotely situated referral centers.

Computer Communication Networks↗
PubMedDate not supplied

Employer health insurance and local labor market conditions.

Theory suggests that an employer's decisions about the amount of health insurance included in the compensation package may be influenced by the practices of other employers in the market. We test the role of local market conditions on decisions of small employers to offer insurance and their dollar contribution to premiums using data from two large national surveys of employers. These employers are more likely to offer insurance and to make greater contributions in communities with tighter labor markets, less concentrated labor purchasers, greater union penetration, and a greater share of workers in big business and a small share in regulated industries. However, our data do not support the notion that marginal tax rates affect employers' offer decision or contributions.

Adult↗
PubMed2007

Ethnicity and risk factors in needle sharing among intravenous drug users in Sichuan Province, China.

Combining survey and ethnographic data, this research examined differences in the risk factors associated with needle sharing amongst intravenous drug users (IDUs) in the Sichuan Province of China. A comparison was made between the province's majority Han population and its Yi minority. We developed a theoretical framework consisting of risk factors at the individual level (including risk factors such as lack of AIDS knowledge, low self-efficacy, and economic pressure), interpersonal level (having an IDU primary partner and lack of family support), and community level (social discrimination). The findings suggested that the Yi minority group was more socially disadvantaged and had a higher risk of contracting HIV than the Han group. Furthermore, the factors that put them at risk were different to those which affected the Han group. OLS regression results showed that, for Han IDUs, needle sharing was positively associated with having an IDU primary partner and with economic pressure. On the other hand, for the minority group, needle sharing was significantly associated with being male, AIDS knowledge, the lack of family support, and social discrimination. These findings highlight the need for HIV prevention work to target marginalized populations in China, such as ethnic minorities, and to tailor appropriate prevention strategies to meet the specific needs of different groups.

Adult↗
PubMed1982

Analysis of antigenic variation in cysticerci of Taenia solium.

By studying the reactions and cross-reactions of antigen extracts from different collections of Taenia solium with their respective hyperimmune antisera, and by using numerical taxonomy to analyze the results, a measure of antigenic diversification within T. solium was established. Results varied somewhat depending on the immunological method employed. Double immunodiffusion and immunoelectrophoresis agreed in that all cysticerci were not identical, but shared approximately one third of their antigens. Double immunodiffusion recognized two groups of identical cysticerci: one included 50% of the cysticerci and the other, 21%. Immunoelectrophoresis was more discriminatory in that it recognized few extracts as identical. Electrophoretic data revealed that the most frequently shared antigen among cysticerci corresponded to that most frequently detected by immunologically responsive humans with cerebral cysticercosis. Antigen diversification of T. solium may provide a possible explanation of the pleomorphic immune response of man to this parasite.U

Animals↗
PubMed2004

Inherent bias toward the null hypothesis in conventional multipoint nonparametric linkage analysis.

Traditional nonparametric "multipoint" statistical procedures have been developed for assigning allele-sharing values at a locus of interest to pairs of relatives for linkage studies. These procedures attempt to accommodate a lack of informativity, nongenotyped loci, missing data, and related issues concerning the genetic markers used in a linkage study. However, such procedures often cannot overcome these phenomena in compelling ways and, as a result, assign relevant relative pairs allele-sharing values that are "expected" for those pairs. The practice of assigning expected allele-sharing values to relative pairs in the face of a lack of explicit allele-transmission information can bias traditional nonparametric linkage test statistics toward the null hypothesis of no locus effect. This bias is due to the use of expected values, rather than to a lack of information about actual allele sharing at relevant marker loci. The bias will vary from study to study on the basis of the DNA markers, sample size, relative-pair types, and pedigree structures used, but it can be extremely pronounced and could contribute to a lack of consistent success in the application of traditional nonparametric linkage analyses to complex human traits and diseases. There are several potential ways to overcome this problem, but their foundations deserve greater research. We expose many of the issues concerning allele sharing with data from a large affected-sibling-pair study investigating the genetic basis of autism.

Alleles↗
PubMed1991

The influence of gender on the susceptibility to multiple sclerosis in sibships.

A population-based study of pairs of relatives (siblings, second- and third-degree) concordant for multiple sclerosis did not show an excess of like-sexed pairs. In addition, data on human lymphocyte antigen typing for sibling pairs concordant for multiple sclerosis did not find an increase in haplotype sharing for like-sexed pairs. These data do not support the notion that sex-related factors influence multiple-sclerosis susceptibility in families.

Disease Susceptibility↗
PubMed1998

Mobile PCIS: point-of-care information systems with portable terminals.

We have developed a Point-of-Care Information System (PCIS) that uses portable terminals and supports the entire loop of daily nursing work for the first time. Nursing work includes a great deal of indirect nursing work, such as documenting patient information, conferring with other health-care providers, and so on, as well as direct patient care. The time needed for this indirect work often exceeds the time actually spent directly caring for patients and needs to be reduced. Our system was developed with the goal of doing this to make nursing work more efficient. The system consists of personal digital assistants (PDAs) that nurses carry in the hospital wards and a server computer located in the nursing station. The system has three main functions: 1) Data Browsing provides patient information such as a brief history, vital-sign charts, and handwritten notes; 2) Schedule Planning helps nurses organize doctors' instructions and make To-do lists for the day; and 3) Care Management reminds nurses when they should execute the doctors' orders and provides tools for data entry. These three functions cover the entire loop of daily nursing work. The PDAs and the server computer can share up-to-date information by data transmission through telephone lines (low-power cellular phones can be used), infrared devices, or RS-232C cables. Results from a preliminary hospital evaluation showed that use of the system can reduce the time needed for nursing documentation by 60% (a 10% saving of a nurse's total working time), and that more than 80% of the nurses who used the system felt it would make nursing work more efficient.

Attitude to Computers↗
PubMed1998

Heritability of blood pressure increases during mental stress.

We studied the influence of mental stress on the contributions of genes and environment to individual variation in systolic (SBP) and diastolic (DBP) blood pressure by structural equation modelling in 320 adolescent male and female twins. Blood pressure data were collected during rest and during a reaction time and a mental arithmetic task. Univariate analyses of SBP and DBP showed familial aggregation for blood pressure. A genetic explanation for this resemblance was most likely, although during rest conditions a model that attributed familial resemblance to shared environmental factors, also fitted the data. There was no evidence for sex differences in heritabilities. Multivariate analyses showed significant heterogeneity between sexes for the intercorrelations of the blood pressure data measured under different rest and task conditions. Multivariate genetic analyses were therefore carried out separately in males and females. For SBP and DBP in females and for SBP in males an increase in heritabilities was seen for blood pressure measured during stress, as compared to rest measurements. The influence of shared environmental factors decreased during stress. For DBP in males no significant contributions of shared environment were found. The multivariate analyses indicated that the same genetic and environmental influences are expressed during rest and stress conditions.

Adolescent↗
PubMed1978

New sharing arrangements meet hospitals' technical support needs.

Just within thid decade, a variety of multihospital arrangements have been developed that make clinical engineering services available to hospitals on a shared basis. This article summarizes available data to describe the diverse approaches and organizational structures into which these programs are evolving.

Biomedical Engineering↗
PubMed1994

Pancreas transplant results in the United Network for Organ Sharing (UNOS) United States of America (USA) Registry compared with non-USA data in the International Registry.

As of 1994, more than 6,300 pancreas transplants were reported to the IPTR. More than 4,300 were performed in the USA, including more than 3,000 since the inception of the UNOS Registry in October 1987. The BD technique was used for 96% of USA cases but only for 64% of non-USA cases. In the overall analysis of USA BD cadaveric pancreas transplants reported to the registry by August 1994 (n = 3,000), patient survival and pancreas graft function survival rates were 91% and 72% at one year, 87% and 67% at 2 years, and 84% and 62% at 3 years, respectively. When the USA data for BD cases were analyzed according to the 3 major recipient categories: SPK, (n = 2584); PAK (n = 241); and PTA (n = 175)], patient survival rates were no different (91%, 91%, and 90% at one year, respectively), but pancreas graft survival rates were significantly higher in the SPK than in the PAK and PTA categories (76%, 47%, and 48%, at one year, respectively). In the SPK group, kidney graft survival rate at one year was 85%. Although the overall results were not as good for non-USA as for USA pancreas transplants, this was probably because the results with non-BD techniques were not as good as when BD was used, and in Europe, more than one-third of the cases were by techniques other than BD. The patient, pancreas, and kidney graft survival rates at one year for BD SPK transplants in Europe (n = 579) and other non-USA locations (n = 66) were similar to those in the USA; in Europe they were 92%, 78% and 84%, respectively. The graft survival rates for solitary pancreas transplants, however, were higher in the USA. Outcomes were also compared according to whether induction immunotherapy in USA recipients included ALG/ATG, OKT3, or neither. In the SPK category, there was no difference among the protocols, with one-year graft survival rates being 76% in the ALG/ATG (n = 1,130), 78% in the OKT3, (n = 927) but 69% in the Neither (n = 294) group (which had a significantly lower graft survival). In the PAK category, the use of OKT3 (n = 49) was associated with lower graft survival rates than when ALG/ATG (n = 154) or neither (n = 37) were given (33%, 51%, and 48% at one year, respectively). In the PTA category, the use of ALG/ATG (n = 109) was associated with significantly higher one-year graft survival rates than when OKT3 (n = 55) or neither (n = 8) were used (52%, 46%, and none, respectively).(ABSTRACT TRUNCATED AT 400 WORDS)

Actuarial Analysis↗
PubMed1983

Apple II computer software for DNA and protein sequence data.

In our attempt to make the aid of a computer for the molecular biology laboratory available on a low-cost basis, we have improved the programs that we published recently. We have experienced in our laboratory, and have learned from others, that the average lab has an increasing demand to use a time-sharing-independent computer for the bulk of data handling. A microcomputer can give this independence. At the same time, a microcomputer can serve as a terminal for the few computer jobs, such as data communication or extensive search programs, which have to be conducted on a time-sharing basis. In this paper, we describe the programs which can be executed on a Apple II microcomputer using the Apple Language System. This system gives the researcher the opportunity to learn to handle sequence data, and it also includes a word processing system useful in writing letters and manuscripts and storing text.

Amino Acid Sequence↗
PubMedDate not supplied

Reading skills in early readers: genetic and shared environmental influences.

The present study combined parallel data from the Northeast-Northwest Collaborative Adoption Projects (N2CAP) and the Western Reserve Reading Project (WRRP) to examine sibling similarity and quantitative genetic model estimates for measures of reading skills in 272 school-age sibling pairs from three family types (monozygotic twins, dizygotic twins, and unrelated adoptive siblings). The study included measures of letter and word identification, phonological awareness, phonological decoding, rapid automatized naming, and general cognitive ability. Estimates of additive genetic effects and shared environmental effects were moderate and significant. Furthermore, shared environmental effects estimated in twins were generally similar in magnitude to adoptive sibling correlations, suggesting highly replicable estimates across different study designs.

Adoption↗
PubMed1999

Fax technology for collecting outcomes data in a computer database.

In this era of cost containment, outcomes research is becoming more prevalent. Therefore, various technologies allowing for flexibility in study design and the capture of specific clinical information need to be examined and used. These technologies include fax data systems, pocket scanners, automated telephone equipment, and hand-held computer devices. Fax data systems convert a fax machine into an automated data-entry system. Data-filled forms are faxed to a computer, the fax is converted, and the data are entered into preset fields in a database. Applications for fax systems include acute care-based and ambulatory care-based drug-use evaluations, drug recall systems, and patient-completed surveys of health status. Pocket scanners are hand-held instruments for rapid data entry and transport. Applications for pocket scanning include patient interview responses, procedure and disease analysis, and procedure coding. Options for automated telephone equipment include surveys with interactive voice-mail responses or keypad data entry, pharmacist-monitored drug information and survey services, fax-back and mail-out services, and patient-generated disease intervention programs. Hand-held computer technology is a source of information on multiple protocols and care pathways. All these technologies improve data collection with respect to accuracy and speed, facilitate data analysis, and promote cost-efficient information sharing. The purpose of this study was to evaluate the use of fax technology in data collection for a prospective, multicenter study of the outcomes and cost-effectiveness of two drugs used in the treatment of cancer. Details for the pharmacoeconomic study can be found elsewhere. Fax technology was selected because of the ease with which those responsible for managing the data collection could be trained to use it, the affordability and efficiency of the technology, the ease with which data could be analyzed, and the accuracy of data collection.

Cost-Benefit Analysis↗
PubMed1985

Human dendritic cells and macrophages. In situ immunophenotypic definition of subsets that exhibit specific morphologic and microenvironmental characteristics.

Using a panel of monoclonal antibodies and antisera in situ, the authors have defined subsets of human dendritic cells and macrophages that exhibit specific morphologic and microenvironmental characteristics. All subsets contained cells that reacted with antibodies directed against HLA-A,B,C, HLA-Dr, leukocyte common, Leu-M3, and Leu-3(T4) antigens. R4/23 and anti-S100 defined three major subsets. R4/23+, S100- cells constituted the B-cell-related follicular dendritic cells, which were identified only within the germinal center/mantle microenvironment of lymphoid follicles. R4/23-, S100+ cells constituted the T-cell-related dendritic cell subset. Anti-Leu-6(T6) further subdivided this group into Leu-6(T6)- interdigitating cells within the T-cell microenvironments of lymphoid organs and Leu-6(T6)+ Langerhans cells found predominantly in epithelial microenvironments, especially the skin. R4/23-, S100- cells constituted the nondendritic tissue macrophage subset which was widely distributed, primarily outside of dendritic-cell microenvironments. These data indicate that although dendritic cells and macrophages share several common antigenic features, morphologically and microenvironmentally distinct subsets express distinct immunologic phenotypes. Such data may provide insight into the ontogeny and function of these subsets and constitute a basis for the comparison of normal dendritic cells and macrophages to various histiocytic proliferative disorders.

Animals↗
PubMed1995

Think globally, act locally: an approach to implementation of clinical practice guidelines.

BACKGROUND: In an environment of concern about the rising costs of medical care, the Vermont Program for Quality in Health Care (VPQHC; the program) was incorporated in 1988 as a nonprofit organization and in 1989 was made a peer review organization by the state legislature. The program acts a resource center for health care in Vermont, coordinating three functions: implementation and maintenance of a statewide database for healthcare quality; training for health care providers in continuous quality improvement (CQI) methods and support for their CQI projects; and focusing clinical study group work on specific diagnoses or procedures. METHODS: The program uses a seven-step process for implementing CQI: pick a process (modify a nationally developed guideline or develop a new guideline); select a team of people involved in doing the work; establish goals and key quality factors; document the clinical process; determine what and how to measure; measure and analyze data; and modify the process to improve. GUIDELINE: This article describes the implementation of a guideline from the American College of Obstetricians and Gynecologists (ACOG) on cesarean section (C-section). Except for a few specific contraindications, the ACOG paper states that it is reasonable to encourage vaginal birth after C-section. A related set of criteria from ACOG states that the benchmark for emergency C-section should be 30 minutes from the decision to proceed with an emergency C-section until the baby is born. CASE STUDY: State C-section rates from 1985-1990 showed wide variation by hospital. Such wide variation is based as much on practice style as on sound science. C-section rates (primary and repeated) were measured, plotted, and shared with Vermont hospitals. Successful vaginal birth after C-section (VBAC) rates from the statewide data-base also were shared. Based on these data, one hospital, Hospital A, developed a plan to lower its repeated C-section rate and improve its VBAC rate. Hospital A collected and reviewed local data, which showed interesting variations. The time from decision to birth became the focus of the overall project; Hospital A designed its project to study events during the time from decision to birth. RESULTS: Most recent data (1992-1993) from Hospital A shows improvement in three areas. First, 89% of patients having emergency C-sections met the goal of a 30-minute time frame from decision to incision. Second, the VBAC success rate for the same time period increased to 85.7% from 69% in the previous year, and from a mere 7% before the implementation of the project. Third, the percentage of total C-sections that were repeat C-sections fell to 36% from a high of 51%. In a follow-up evaluation, one-third of the C-section performed from October 1, 1993, to July 31, 1994 were performed because of patient refusal to attempt VBAC, suggesting that there is a communitywide culture that influences behavior. A major effort at patient education on VBAC is underway. CONCLUSIONS: Think globally, act locally, might be the motto for the program. Implementing guidelines starts with obtaining national guidelines and literature but needs the use of local data to sharpen the focus on narrow areas to address. Specifically, it is unrealistic to tackle the entire problem at once. Success comes from finding specific opportunities for improvement.

Cesarean Section↗
PubMedDate not supplied

State payment limitations on Medicare cost-sharing: impact on dually eligible beneficiaries.

The Balanced Budget Act (BBA) of 1997 allowed states to limit how much their Medicaid programs contributed toward the Medicare cost-sharing liability of dually eligible beneficiaries. Policymakers have grown concerned that such limitations may affect access to care for these beneficiaries. We used a quasi-experimental design to analyze changes in access from 1996 to 1998, using Medicare and Medicaid data from nine states. Cost-sharing payments fell in six of the nine states following the BBA, and access to outpatient physician visits for dually eligible beneficiaries was reduced relative to non-dually eligible beneficiaries in those states.

Aged↗
PubMedDate not supplied

Needles that kill: modeling human immunodeficiency virus transmission via shared drug injection equipment in shooting galleries.

Case notification data from the U.S. Centers for Disease Control imply that AIDS has spread rapidly among intravenous drug users in the northeastern United States. These data determine a doubling time for AIDS cases of 5-6 months for this population early in the epidemic. A new mathematical model of transmission of human immunodeficiency virus (HIV) via shared drug injection equipment in "shooting galleries" is developed to understand the rapid spread of HIV and AIDS among drug users. The model depends on quantities such as rates of sharing injection equipment, the ratio of addicts to injection equipment in the population, the infectivity of HIV transmitted by shared injection equipment, the likelihood that infectious equipment is "flushed" by the blood of an uninfected user, and the duration of needle-sharing activity by HIV-infected addicts. The model is extended to incorporate the impact of cleansing or bleaching of injection equipment. Also, the model is reformulated to account for the inactivation of HIV infectiousness over time. The models demonstrate that policies such as the distribution of cleansing solutions and/or injection equipment among drug addicts could slow or stop the intravenous transmission of HIV in shooting galleries.

Acquired Immunodeficiency Syndrome↗

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