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PubMedDate not supplied

Kaiser Permanente Colorado Region Pharmacy Department: innovative leader in pharmacy practice.

OBJECTIVE: To describe innovative programs within the Kaiser Permanente Pharmacy Department in the Colorado Region. SETTING: One of eight regions of the nation's largest nonprofit health maintenance organization. PRACTICE DESCRIPTION: The pharmacy department comprises two services, Clinical Pharmacy Services and Pharmacy Operations/Support Services, which are integrated to provide comprehensive care. PRACTICE INNOVATION: Within Clinical Pharmacy Services, the Primary Care Clinical Pharmacy Services team works alongside physicians to provide integrated patient care. The Centralized Clinical Pharmacy Service teams manage large groups of patients effectively and efficiently. The Clinical Pharmacy Specialty staff and the Disease State Management clinical pharmacy specialists provide focused drug therapy expertise. MAIN OUTCOME MEASURES: Clinical and economic outcomes; recognition by national organizations. RESULTS: Technological innovations are used within Pharmacy Operations/Support Services to increase pharmacists' time for patient care activities. The use of technology by the Pharmacy Automated Refill Center and the implementation of ScriptPro in the medical office pharmacies decrease dispensing demands by processing large volumes of prescriptions. Workflow in the medical office pharmacies has also been reengineered to increase efficiency. Various programs have been developed by the Pharmacy Information Technology Service to support patient care initiatives. Benchmark clinical and economic outcomes have been demonstrated. Positive outcomes have also resulted in quality and safety awards and captured the attention of national pharmacy and medical organizations. CONCLUSION: The Colorado Region Pharmacy Department has been recognized as a leader in pharmacy practice through the development of innovative services that provide exceptional patient care.

Anticoagulants↗
PubMed2004

Clinical and molecular aspects of haemoglobinopathies in Tunisia.

BACKGROUND: For the last two decades, studies on the population genetics of Tunisians have focused on variations of protein and genetic markers. Results confirmed the genetic heterogeneity of Tunisians caused by the admixtures with migratory human groups arriving mainly from Africa, Europe, and Asia. These studies also allowed the screening of rare mutants and many haemoglobin variants. METHODS: The present study delineates the incidence of the different haemoglobinopathies in Tunisia. Previously collected data and results obtained from epidemiological and clinical studies of 1238 blood donors and 276 patients were compared. The chromosomal backgrounds of different haemoglobinopathies were explored by molecular techniques (denaturing gradient gel electrophoresis (DGGE), amplification refractory mutation system (ARMS) polymerase chain reaction (PCR), and sequencing). RESULTS: This study indicates that appropriate DNA methodologies required for a nationwide preventive program in Tunisia are available and that prenatal diagnosis is feasible. Additionally, analysis of sequence polymorphisms allowed a better understanding of the gene recombination events and their application for tracing back the origin and the diffusion of the mutations. CONCLUSIONS: Molecular analysis techniques such as DGGE and ARMS PCR are socially and economically the most suitable techniques to be used in Tunisia for the detection and the identification of haemoglobin abnormalities. At present, their use is essential to conduct a clear and efficient screening program.

Anemia, Sickle Cell↗
PubMed2002

PRIMEGENS: robust and efficient design of gene-specific probes for microarray analysis.

MOTIVATION: DNA microarray is a powerful high-throughput tool for studying gene function and regulatory networks. Due to the problem of potential cross hybridization, using full-length genes for microarray construction is not appropriate in some situations. A bioinformatic tool, PRIMEGENS, has recently been developed for the automatic design of PCR primers using DNA fragments that are specific to individual open reading frames (ORFs). RESULTS: PRIMEGENS first carries out a BLAST search for each target ORF against all other ORFs of the genome to quickly identify possible homologous sequences. Then it performs optimal sequence alignment between the target ORF and each of its homologous ORFs using dynamic programming. PRIMEGENS uses the sequence alignments to select gene- specific fragments, and then feeds the fragments to the Primer3 program to design primer pairs for PCR amplification. PRIMEGENS can be run from the command line on Unix/Linux platforms as a stand-alone package or it can be used from a Web interface. The program runs efficiently, and it takes a few seconds per sequence on a typical workstation. PCR primers specific to individual ORFs from Shewanella oneidensis MR-1 and Deinococcus radiodurans R1 have been designed. The PCR amplification results indicate that this method is very efficient and reliable for designing specific probes for microarray analysis.

Algorithms↗
PubMed2001

Variants within the "a" determinant of HBs gene in children and adolescents with and without hepatitis B vaccination as part of Thailand's Expanded Program on Immunization (EPI).

A total of 2229 children selected from five distinct areas of Thailand were screened for HBs antigen (HBsAg) by ELISA. Out of 51, forty-nine HBsAg-positive children were further examined for HBV-DNA by the polymerase chain reaction, utilizing the region of the hepatitis B Virus (HBV) genome encoding the major antigenic epitopes of hepatitis B surface antigen. Direct automated sequencing of the "a" determinant region revealed 11 of 49 children to display variable mutations. The vaccinated and nonvaccinated children had amino acid variants clustered between residues 120 and 160. Mutations between residues 120 and 160 were found at higher frequency in the vaccinated group (4/13; 30.8%) than in the nonvaccinated group (7/36; 19.4%), but this was not statistically significant. Infections with new HBV variants are contracted either vertically or horizontally within the group having received the vaccine, a finding confirmed by the presence of amino acid substitutions critical for immune escape. Hence, neither vaccine nor IgG has any apparent effect on those variants and the children turn into HBV carriers. However, the current vaccination program still efficiently protects perinatal transmission of HBV and unless long term studies lead us to conclude otherwise, inclusion of the variant strain(s) into a new vaccine formulation is not deemed necessary.

Adolescent↗
PubMed2001

Ribosomal protein L5 helps anchor peptidyl-tRNA to the P-site in Saccharomyces cerevisiae.

Our previous demonstration that mutants of 5S rRNA called mof9 can specifically alter efficiencies of programmed ribosomal frameshifting (PRF) suggested a role for this ubiquitous molecule in the maintenance of translational reading frame, though the repetitive nature of the 5S rDNA gene (>100 copies/cell) inhibited more detailed analyses. However, given the known interactions between 5S rRNA and ribosomal protein L5 (previously called L1 or YL3) encoded by an essential, single-copy gene, we monitored the effects of a series of well-defined rpl5 mutants on PRF and virus propagation. Consistent with the mof9 results, we find that the rpl5 mutants promoted increased frameshifting efficiencies in both the -1 and +1 directions, and conferred defects in the ability of cells to propagate two endogenous viruses. Biochemical analyses demonstrated that mutant ribosomes had decreased affinities for peptidyl-tRNA. Pharmacological studies showed that sparsomycin, a peptidyltransferase inhibitor that specifically increases the binding of peptidyl-tRNA with ribosomes, was antagonistic to the frameshifting defects of the most severe mutant, and the extent of sparsomycin resistance correlated with the severity of the frameshifting defects in all of the mutants. These results provide biochemical and physiological evidence that one function of L5 is to anchor peptidyl-tRNA to the P-site. A model is presented describing how decreased affinity of ribosomes for peptidyl-tRNA can affect both -1 and +1 frameshifting, and for the effects of sparsomycin.

Alleles↗
PubMed2004

Analytical energy gradients for local second-order Møller-Plesset perturbation theory using density fitting approximations.

An efficient method to compute analytical energy derivatives for local second-order Møller-Plesset perturbation energy is presented. Density fitting approximations are employed for all 4-index integrals and their derivatives. Using local fitting approximations, quadratic scaling with molecular size and cubic scaling with basis set size for a given molecule is achieved. The density fitting approximations have a negligible effect on the accuracy of optimized equilibrium structures or computed energy differences. The method can be applied to much larger molecules and basis sets than any previous second-order Møller-Plesset gradient program. The efficiency and accuracy of the method is demonstrated for a number of organic molecules as well as for molecular clusters. Examples of geometry optimizations for molecules with 100 atoms and over 2000 basis functions without symmetry are presented.

Journal Article↗
PubMed2005

[Understanding CAD (computer-aided diagnosis) in mammography].

Generalization of breast screening programs requires efficient double reading of mammograms, which allows reduction of false negative interpretations, but it may be difficult to achieve. CAD (Computed Aided Detection) systems are dramatically improving and can now assist in the detection of suspicious mammographic lesions, either suspicious microcalcifications, masses or architectural distortion. Characterization of the lesions is improving as well. CAD mammography might complete or substitute to "human" double reading. The aim of this review is to present the main CAD systems commercially available, review the principles of CAD and discuss the results of CAD mammography. Specifically, the role of CAD within breast screening program, according to the results of recent prospective studies will be discussed.

Breast Diseases↗
PubMed1986

A hypothesis-testing approach to treatment of a child with an idiosyncratic (morpho)phonological system.

Evaluation of a 6-year-old language-impaired girl's phonological and morphophonological systems revealed several idiosyncratic characteristics. Three hypotheses regarding the nature of this child's impairment were developed and then tested by monitoring the child's progress in therapy. The results of the intervention program supported all three hypotheses in principle. It is concluded that phonologically impaired children must learn to communicate facing articulatory and linguistic constraints similar to but often greater than those influencing the performance of younger normally developing children. It can be expected, then, that these children often will use phonological rules commonly found among normal children. It should also be expected that they occasionally will be led to phonological and morphological solutions to their communication problems that are unusual, if not idiosyncratic. The hypothesis-testing approach used in this investigation is advocated as a useful step in the development of an efficient intervention program and as a means of gaining insight into the nature of children's phonological and morphological impairments.

Child↗
PubMed2001

Mammography screening in Norway: results from the first screening round in four counties and cost-effectiveness of a modeled nationwide screening.

OBJECTIVE: To evaluate whether the results of the first screening round in the Norwegian Breast Cancer Screening Program predict future mortality reduction and to explore the cost-effectiveness of the program. METHODS: The results of surrogate measures were calculated and compared with the targets. A cost-effectiveness analysis was performed assuming a nationwide program starting in 1996 with an attendance rate of 80% and a mortality reduction of 30%. RESULTS: The attendance rate was 79.5% and the detection rate was 0.67%. The proportion of invasive tumors smaller than 15 mm was 53.1%, and 21.7% of the patients who underwent axillary surgery had lymphatic metastasis. The C/E ratios were found to be 3750 US dollars (USD) per year of life saved and 86,045 USD per life saved. CONCLUSION: The results of the first screening round will lead to a mortality reduction of at least 30%. The cost-effectiveness analysis shows that it is possible to run a highly cost-efficient screening program in Norway.

Aged↗
PubMed1991

Premiums without benefits: waste and inefficiency in the commercial health insurance industry.

The U.S. system of health insurance is wasteful and inefficient. For every dollar the commercial health insurance industry paid in claims in 1988, the industry spent 33.5 cents for administration, marketing, and other overhead expenses. Thus, not including profits, the commercial insurance industry spent 14 times as much on administration, overhead, and marketing per dollar of claims paid as did the Medicare system, and 11 times as much per dollar of claims paid as the Canadian national health system. Had an efficient public program such as Medicare or the Canadian system provided the same amount of benefits, consumers and businesses served by commercial insurers would have saved $13 billion. The sources of waste include excessive marketing costs and administrative costs bloated by discriminatory underwriting practices that segregate the profitable groups and individuals--people who are healthy, young, and in "safe" professions--from everyone else.

Canada↗
PubMed1997

High level expression of the major antigenic African swine fever virus proteins p54 and p30 in baculovirus and their potential use as diagnostic reagents.

At present, the eradication of African swine fever (ASF) in affected countries is based only on an efficient diagnosis program because of the absence of an available vaccine. The highly antigenic ASF virus proteins p54 and p30, encoded by genes E183L and CP204L respectively, were expressed in baculovirus for diagnostic purposes. A sequence comparison analysis of these genes from different field virus strains which are geographically diverse and isolated in different years, revealed that both genes are completely conserved among the isolates. Partially purified baculovirus-expressed proteins were used in ELISA and Western blot for ASF antibody detection in sera from experimentally inoculated pigs and field sera from ASF innaparent carriers. These comparative analyses showed that p54 presents better reactivity than p30 in Western blot. However, recombinant p30 was more efficient for antibody detection by ELISA, improving the discrimination between positive and negative sera by this technique. These data suggest the convenience of using p30 as ELISA antigen, while p54 should be the selected antigen for ASF virus antibody detection by Western blot. The combined use of both antigens for serodiagnosis of ASF disease will improve the sensitivity of innaparent carriers detection, facilitating also the interpretation of the tests, and eliminating the use of ASF virus in antigen production.

African Swine Fever↗
PubMed2001

Control of DNA excision efficiency in Paramecium.

Programmed excision of internal eliminated sequences (IESs) occurs at thousands of sites in ciliate genomes. How this is controlled is largely unknown. Here, we report the characterization of the non-efficiently excised 156psiG-11 IES from Paramecium primaurelia strain 156 and that of the efficiently excised 168psiG-11 IES, an allelic variant from strain 168. Then, we report a genetic and molecular analysis of IES excision efficiency in F(1) progeny derived from interstrain crosses and in F(2) homozygous progeny derived from F(1) autogamy. IES 168psiG-11 excision efficiency was approximately 100% in all cases. IES 156psiG-11 excision efficiency was 19 +/- 13% in F(1) progeny and 0.6 +/- 1.1% in F(2) progeny. No trans-excision event between IESs 156psiG-11 and 168psiG-11 was detected within the F(1) progeny. These data demonstrate that the excision efficiency of this IES is variable and controlled by a cis-acting element. This should encompass positions 8 and/or 9 of the right IES end, which display allele differences. Finally, the 30-fold stimulation of IES 156psiG-11 excision efficiency within F(1) progeny relative to F(2) progeny demonstrates that Paramecium IES excision efficiency is sensitive either to a conjugation-specific trans-acting factor provided by the zygotic genome, or to homologous chromosome cross-talk.

Alleles↗
PubMed2002

Interfacility transports.

Financial pressures exerted by managed care organizations toward hospitals to improve efficiencies and to lower total healthcare costs continue to force physicians and administrators to reevaluate operations and practices. This shifting of risk exposure from insurers to providers has resulted in many mergers, acquisitions, and affiliations, so as to form integrated health systems that reduce repetition and duplication of services. Therefore, as these integrated systems develop, along with the emergence of tertiary care, regional referral, and specialty hospitals, the need for patient transfers between such facilities will expand. The decision to move patients between facilities is a multicomponent process comprising health, safety, financial, and legal concerns. Interfacility transportation of patients has been performed over the past 20 to 30 years. Whereas ground transport services were prominent in the 1970s, air medical programs using helicopters and fixed-wing aircraft have recently become widespread. Both hospital-based and private agencies have continued to develop programs for efficiently and expeditiously transporting critically ill or injured patients, many requiring complex life-support devices. The Practice Management Committee of the American College of Emergency Physicians recently updated the 1990 policy statement on interfacility transfers, and two position statements are available from the National Association of EMS Physicians on criteria for air medical transport and medical direction for interfacility transport services. This review provides an overview of transportation systems and services available and assists physicians in understanding the various modes and characteristics of systems available. Personnel configurations and capabilities, physiological limitations, inherent requirements for equipment and patient preparation, and legal issues involved with transferring patients are also outlined.

Journal Article↗
PubMed2004

[Conservation efficiency of local chicken breeds in different farms as revealed by microsatellite markers].

Twenty-eight microsatellite markers were used to analyze the conservation efficiency of two local chicken breeds (Dagu Chicken and Beijing Fatty Chicken) in different farms. Genotypes were detected in 125 samples. The genetic variations among and within the populations were calculated by the number of alleles, gene frequency, genetic heterozygosity (H), PIC, F-statistics, Nei's genetic distance and UPGMA. High polymorphism was found in the four populations, and H and PIC values of each population were more than 0. 5. All loci detected in the study showed polymorphism and the number of alleles ranged from 2 to 22 in total population. Most of these loci were at Hardy-Weinberg equilibrium except two loci (LE110194, MCW0032). The four conservation farms for the two breeds were shown to have retained substantial biodiversity, indicating that the conservation programs are efficient. However, differences between the farms of the same breeds were observed.

Animals↗
PubMedDate not supplied

Home parenteral nutrition: a hospital-based program with commercial logistic support.

Since home parenteral nutrition was introduced in the 1970's, a number of medical centers have formed successful home parenteral nutrition programs which have reduced expenses to the patient and third party payers by 50 to 73% over in hospital costs. However, the cost of maintaining these programs for training and follow-up has largely been absorbed by the hospital as a nonreimbursable teaching expense. To offset the costs of our growing program in these times of budget "caps," we have established an agreement between our hospital and commercial home care company which provides for patient instruction and follow-up by the hospital parenteral and enteral nutrition team and logistic support by the home care company. We used the average cost of our first five patients to establish a fee schedule which the commercial company agreed to pay the hospital parenteral and enteral nutrition team for its services. This agreement reduces the number of nurses and pharmacists that the commercial company would otherwise have to hire for teaching and follow-up of home care patients, and supports the concept of regional care in medical centers where parenteral and enteral nutrition teams maintain quality control, continuity of care, and efficient teaching programs for patients requiring home parenteral nutrition.

Delivery of Health Care↗
PubMed2004

Enhancing medication adherence: clinician outcomes from the Medication Alliance training program.

OBJECTIVE: Patient nonadherence to psychiatric medication is a key cause of relapse but clinicians do not appear to possess specific adherence skills. We sought to demonstrate that a brief training program on medication adherence strategies could improve the adherence skills, attitudes and knowledge of mental health clinicians. METHODS: Twenty-three Tasmanian mental health workers were provided a 3 day training workshop on strategies to enhance patient adherence to medications (Medication Alliance). Pre- and post-training measures were taken of clinician knowledge about adherence strategies, ability to identify predictors of nonadherence, attitudes toward working with nonadherent patients, and optimism about treatment outcomes for patients. Videotapes of clinicians demonstrating key adherence therapy skills were also collected before and after training and blind-rated by two experienced therapists. RESULTS: A series of paired samples t-tests indicated significant improvements in skills, knowledge and attitudes. CONCLUSIONS: Compared with similar studies in the UK, Medication Alliance was found to be an effective and efficient training program. However, there is a need for further research to assess maintenance of training effects over time and patient outcomes.

Adult↗
PubMed2002

[Thiel method fixed cadaver ears. A new procedure for graduate and continuing education in middle ear surgery].

BACKGROUND AND OBJECTIVE: An efficient training program in ear surgery needs suitable models to learn the specific preparation techniques. However, conventionally fixed or fresh frozen ears of human corpses do not meet all demands. Therefore we investigated the feasibility of ears fixed according to Thiel for surgical training in the temporal bone lab. METHODS: Various surgical techniques on external and middle ears were evaluated on ears from cadavers fixed according to Thiel. Structure and consistency of the tissues were compared to vital conditions by means of a standardized questionnaire. RESULTS: Structure and consistency of the tissues of the auditory canal, the tympanic cavity and the mastoid were comparable to vital conditions. Merely the cartilage of the auricle was considerable softened. This enabled a surgical preparation under conditions close to the intravital situation. CONCLUSIONS: Under the aspects of quality assurance and efficiency of continuous medical education in middle ear surgery, the Thiel fixation technique provides an excellent prerequisite.

Cadaver↗
PubMed1992

Ischemic heart disease prevention: estimating the impact of interventions.

The potential impact of ischemic heart disease intervention programs has usually been assessed using the dichotomy between those programs targeted to high risk groups and those that are population based, but this distinction does not adequately describe the spectrum of possibilities. Using data from the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (NHEFS), we assessed the effect of a spectrum of 27 potential interventions on mortality reduction and on an Intervention Index (defined as the number of persons whose risk must change to prevent one death). Using combinations of cholesterol reductions of 20% and decreases in the prevalence of smoking and hypertension of 50%, reductions in mortality varied from 1 to 27% and the Intervention Index varied from 26 to 520. A number of potential interventions were equivalent in their mortality reduction of their Intervention Indexes, despite their affecting differing proportions of the population. The Intervention Index provides some measure of the relative efficiency of programs and points to the comparability of different interventive approaches. In addition, this analysis suggests that the potential impact of intervention programs on mortality will be modest, but that a focus on certain subgroups, such as those aged 40-59 years, can achieve substantial results within those groups, even though the population effect would be minimal.

Adult↗