System integration--foundation for clinical decision support.
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The Values in Leadership program, a new leadership development program created by the Sisters of Charity Health Care Systems (SCHCS), is designed to empower effective leaders to live out personal values compatible with those of the organization. The program, designed for middle and senior managers, comprises seven educational modules- Living Our Values; Valuing Individual Differences; Leader as Servant; Leader as Visionary; Leader as Catalyst; Leader as Mentor; Formative Leadership; and Leader as Mentor; Motivational Coaching. Throughout the sessions, participants discuss the four roles of an effective leader-servant, visionary, catalyst, and mentor-which are grounded in SCHCS core values. Participants are also challenged to identify specific actions that can be integrated into their leadership styles. These actions, drawn from SCHCS leadership practices and core values, are reinforced when participants return to their jobs and write plans to incorporate these practices into their daily work.
The ability to capture both financial and clinical data is at the heart of integrating the insurance and delivery functions.
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Space exploration missions will require combining human and technical subsystems into overall "crew systems" capable of performing under the rigorous conditions of outer space. This report describes substantive and conceptual relationships among humans, intelligent machines, and communication systems, and explores how these components may be combined to complement and strengthen one another. We identify key research issues in the combination of humans and technology and examine the role of individual differences, group processes, and environmental conditions. We conclude that a crew system is, in effect, a social cyborg, a living system consisting of multiple individuals whose capabilities are extended by advanced technology.
The performance of an implantable left ventricular assist system (LVAS) utilizing a pulsed solenoid energy converter and a pusher-plate blood pump has been characterized in vitro and in vivo. A microprocessor-based electronic control system makes the LVAS completely self-regulating over the range of operating conditions and provides considerable flexibility in various assist modalities. Over forty thousand hours of in vitro and in vivo operating experience has been accumulated with current systems, and significant progress has been acheived in system durability and reliability. A new toggle latch has provided nearly a year of failure-free operation on the bench, without measurable wear. Energy converter efficiencies of 50% have been demonstrated. In vivo evaluation has been highlighted by an animal experiment still in progress after nearly four months of fault-free, continuous synchronous pumping.
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A system to provide quantitative information on the angle between dentition and face was developed using a three-dimensional (3D) integrated configuration measured by a non-contact 3D digitizer. The integrated configuration angles between the Camper's plane and occlusal plane on the sagittal and the horizontal projected planes were obtained. Clinical application for a patient to improve the tegmenta of the anterior tooth by setting a temporary bridge on her lower dentition was attempted. Her dentition and face were measured on her first visit and after treatment, and 3D data of them were integrated. The quantitative change of the angle between the Camper's plane and lower occlusal plane were successfully analyzed by the present system, and after treatment, rotation of the lower occlusal plane for 1 degrees in a clockwise direction on the sagittal plane projection, and that for 1 degrees in a counterclockwise direction on the horizontal plane projection relative to the Camper's plane were detected.
There is little knowledge of the functional performance of patients with talocalcaneal coalition because of the marginal quantitative information accessible using current motion-analysis and plantar pressure-measurement techniques. A novel system was developed for comprehensively measuring foot-floor interaction during the stance phase of gait that integrates instrumentation for simultaneously measuring bony segment position, ground reaction force, and plantar pressure with synchronization of spatial and temporal variables. An advanced anatomically based analysis of foot joint rotations was also applied. Tracking of numerous anatomical landmarks allowed accurate selection of three footprint subareas and reliable estimation of relevant local forces and moments. Eight patients (11 feet) with talocalcaneal coalition were analyzed. Major impairment of the rearfoot was found in nonsurgical patients, with an everted attitude, limited plantarflexion, and overloading in all three components of ground reaction force. Surgical patients showed more normal loading patterns in each footprint subarea. This measuring system allowed for accurate inspection of the effects of surgical treatment in the entire foot and at several footprint subareas. Surgical treatment of talocalcaneal coalition seems to be effective in restoring more physiologic subtalar and forefoot motion and loading patterns.
A community mental health--mental retardation center developed a computerized problem-oriented record system specifically for use in a full-service community mental health center. It is based on an integrated set of clinical forms that covers all levels of a client's involvement with the center, beginning with his contact as a prospective client and including intake, treatment planning, treatment, and discharge. Most of the forms are computer-generated. Special features of the system include its capability to prompt the clinician about scheduled treatment sessions, follow-ups, and other activities and a scale that rates the client's level of functioning and is keyed to a specially developed master problem list. The authors describe each of the clinical forms used in the system.
Computer simulators play an important role in medical education. We have extended our simulator EchoComJ with an intelligent training system (ITS) to support trainees adjusting echocardiographic standard views. EchoComJ is an augmented reality application that combines real three-dimensional ultrasound data with a virtual heart model enabling one to simulate an echocardiographic examination. The ITS analyzes the image planes according to their position, orientation and the visualization of anatomical landmarks using fuzzy rules. An adaptive feedback is provided that colors the specific anatomic landmarks within the contours of the virtual model based on the quality of the image plane.
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