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PubMed1996

User requirements on the future laboratory information systems.

Today numerous information technology solutions exist for the clinical laboratory which operate either as stand-alone functionalities or with ad hoc integration solutions. The OpenLabs (A2028) AIM Project puts emphasis on the design and specification of a framework for the interoperability of existing systems and new advanced services, and consequently concentrates on the issue of integration. The purpose of the OpenLabs open architecture is to serve as a functional solution to this integration. A basic principle for this open architecture is that each of the advanced services shall be able to function individually or in any combination with an existing Laboratory Information System (LIS), and that it shall enable new modular functionalities to be incorporated in a 'plug-and-play' fashion. The synthesis of the main user needs and requirements implies that the future IT solutions: (a) must be highly flexible and maximally customizable--by the users themselves; (b) are based on the concept of open systems, both technically and functionally, which enables modular functionalities from different vendors to co-operate forming a global LIS functionality; (c) are future viable and able to incorporate already installed IT functionalities; (d) support management of failure prevention, of repair, of success, and of change. The establishment of an open architecture implies that a market will develop for modular, scaleable, and cost-effective LIS features without today's dependence on individual manufacturers and hardware/software platforms.

Clinical Laboratory Information Systems↗

PubMed2005

Neurobiological basis of depression: an update.

The past 5 years have seen unprecedented advances in our knowledge about the neurobiology of depression. Significant breakthroughs have been made in genomics, imaging, and the identification of key neural systems involved in cognition, emotion, and behavior. In addition, novel targets have been identified for the development of new pharmacological and behavioral treatments. Genetic variations associated with most mental disorders are being identified, and reliable tests for early detection of risk and disease are now on the horizon. New neurobiological concepts have emerged, as they relate to these advances in mental health research such as the serotonin transporter receptor, a genetic variant of which doubles the risk of depression. Brain neurochemicals, including neurotropic factors (implicated in several mental disorders), and anatomical studies involving imaging of the amygdala and the hippocampus and prefrontal cortex are now at the forefront. Several brain neurotransmitters systems: glutamate, gamma -aminobutyric acid, serotonin, norepinephrine, and dopamine have been implicated in depression and mania. These transmitter systems, as well as other neurochemical systems such as membrane-bound signal transduction systems and intracellular signaling systems that modulate gene transcription and protein synthesis, play an important role in the etiology of depression. This new knowledge is expected to provide important clues for the development of selective pharmacological interventions. Neuroimaging studies of depressed patients have shown several abnormalities of regional cerebral blood flow and glucose metabolism--a surrogate of neuronal function--in various brain regions, including the limbic cortex, the prefrontal cortex, the hippocampus, the amygdala, and the anterior cingulate cortex. At this time, a considerable amount of new information is converging--derived from animal models of mood disorders, genetics, basic behavioral research, and neuroscience. It is inevitable that the next step in this progression will be the integration of these basic advances in clinical management and the application of this new information in the context of the depressed patient.

Animals↗

PubMed2002

Public health, GIS, and the internet.

Internet access and use of georeferenced public health information for GIS application will be an important and exciting development for the nation's Department of Health and Human Services and other health agencies in this new millennium. Technological progress toward public health geospatial data integration, analysis, and visualization of space-time events using the Web portends eventual robust use of GIS by public health and other sectors of the economy. Increasing Web resources from distributed spatial data portals and global geospatial libraries, and a growing suite of Web integration tools, will provide new opportunities to advance disease surveillance, control, and prevention, and insure public access and community empowerment in public health decision making. Emerging supercomputing, data mining, compression, and transmission technologies will play increasingly critical roles in national emergency, catastrophic planning and response, and risk management. Web-enabled public health GIS will be guided by Federal Geographic Data Committee spatial metadata, OpenGIS Web interoperability, and GML/XML geospatial Web content standards. Public health will become a responsive and integral part of the National Spatial Data Infrastructure.

Geographic Information Systems↗

PubMed1993

ARTEMIS: a collaborative framework for health care.

Patient centered healthcare delivery is an inherently collaborative process. This involves a wide range of individuals and organizations with diverse perspectives: primary care physicians, hospital administrators, labs, clinics, and insurance. The key to cost reduction and quality improvement in health care is effective management of this collaborative process. The use of multi-media collaboration technology can facilitate timely delivery of patient care and reduce cost at the same time. During the last five years, the Concurrent Engineering Research Center (CERC), under the sponsorship of DARPA (Defense Advanced Research Projects Agency, recently renamed ARPA) developed a number of generic key subsystems of a comprehensive collaboration environment. These subsystems are intended to overcome the barriers that inhibit the collaborative process. Three subsystems developed under this program include: MONET (Meeting On the Net)--to provide consultation over a computer network, ISS (Information Sharing Server)--to provide access to multi-media information, and PCB (Project Coordination Board)--to better coordinate focussed activities. These systems have been integrated into an open environment to enable collaborative processes. This environment is being used to create a wide-area (geographically distributed) research testbed under DARPA sponsorship, ARTEMIS (Advance Research Testbed for Medical Informatics) to explore the collaborative health care processes. We believe this technology will play a key role in the current national thrust to reengineer the present health-care delivery system.

Computer Communication Networks↗

PubMed2002

Health care in the information society. A prognosis for the year 2013.

Our society is increasingly influenced by modern information and communication technology (ICT). Health care has profited greatly by this development. How could health care provision look in the near future, in 10 years, or more precisely, in the year 2013? What measures must be undertaken by political and self-governing health institutions, and by medical informatics research, to ensure an efficient, medically advanced and yet affordable future health care system? Three factors will greatly influence the further development of information processing in health care within the near future: the development of the population, medical advances, and advances in informatics. These factors have motivated us to set up 30 theses for health care provision in the year 2013. The theses cover areas of health care, such as its people, its information systems, and its ICT tools. Three major goals requiring achievement have been identified: patient-centered recording and use of medical data for cooperative care, process-integrated decision support through current medical knowledge, comprehensive use of patient data for research and health care reporting. In consequence, political institutions should provide a framework for networked, patient-centered health care. They are called on to regulate the storage and exchange of health care data and of appropriate information system architectures. Finally, the health care institutions themselves must emphasize professional information management more strongly. Relevant research topics in medical informatics are: comprehensive electronic patient records, modern health information system architectures, architectures for medical knowledge centers, specific data processing methods ('medical data mining'), and multi-functional, mobile ICT tools.

Adolescent↗

PubMed2005

Electronic health record systems: the vehicle for implementing performance measures.

Advances in information technology and recent national directives have the potential to support dramatic improvements in health care. Two key components are the implementation of functional electronic health record systems and widely accepted, evidence-based clinical performance measures for physicians. Midwest Heart Specialists, a 55-physician cardiovascular group at 14 locations in northern Illinois, has utilized an outpatient electronic health record system since 1997. Since 2003, the group has integrated cardiovascular measurement sets developed by the American Medical Association-convened Physician Consortium for Performance Improvement into its electronic health record system. With this integration, the group was able to capture data needed for internal quality assessment and improvement as part of routine outpatient care without the need for additional resources. Critical disease-management data for decision support are available continuously, resulting in improvements in health care. The reporting of these standardized data could be the foundation to support quality-based reimbursement strategies and physician office-based disease-management strategies.

Evidence-Based Medicine↗

PubMed2001

Making IT better.

The body of the healthcare sector is today supported by a nervous system of advanced technology infrastructure that has become vital to its efficient operation. The sharing of information between hospitals, clinics, surgeries and administrative units has become a key part of the everyday activities of the sector, streamlining processes and giving healthcare professionals access to stored knowledge that would otherwise be unavailable. Supporting this 'nervous system' are the companies that supply and maintain the networks and technology on which the sector now relies.

Information Management↗

PubMed1995

The OpenLabs approach to clinical laboratory computing.

This paper describes the architectural infrastructure to support a number of advanced functionalties for the clinical laboratory developed by OpenLabs. This infrastructure is based on an open distributed computing platform. A brief overview is given of the advanced functionalities provided by the OpenLabs modules through the novel application of knowledge-based systems, databases, and telematics; we also describe the communications architecture which allows these modules to interoperate with each other and with existing Laboratory Information Systems and instruments. The OpenLabs approach to the provision of generic interfaces to such existing systems is described, together with the OpenLabs Service Manager which supports the automated management of the laboratory in this distributed computing environment.

Artificial Intelligence↗

PubMed2004

Translating research findings of chronic kidney disease management to clinical practice: Challenges and opportunities.

Chronic Kidney disease (CKD) has been identified as a public health epidemic, fueled in part by improved outcomes of both diabetic and cardiac patient populations, as well as by the increasing recognition that it is possible to identify CKD at earlier stages. The estimated 8 to 10 million Americans that have CKD, with its concomitant morbidity and mortality, have the potential to overwhelm the current system of specialty practice medicine and health care resources. How can clinicians, clinician scientists, and health care administrators translate research findings into clinical practice in an effective manner to improve the care of this burgeoning patient group? The challenge of translating research into clinical care requires identification of that which we do and do not know, communication of knowledge between those who do and do not know, and efficient collection of information for systematic evaluation. This article will describe the challenges of translating current research findings into clinical practice. There is a need to identify the complexity of CKD disease processes and issues associated with delivery of care and to describe the difficulties in the dissemination of new knowledge to physicians. Because of the propensity of CKD to affect identifiable groups of patients, we will discuss the potential challenges of these strategies given the racial, ethnic, and cultural diversity in North America. A potential solution to these challenges is a new paradigm of "process-based medicine" that integrates clinical and basic science research findings with multidisciplinary and shared care models of health care delivery. In this context, attention to advances in information technology, the cognitive processes that underlie physician learning, and the findings of outcome research may ensure true integration of clinical research and clinical practice.

Communication Barriers↗

PubMed1996

Trauma system development in Armenia.

UNLABELLED: A medical partnership program between Boston University School of Medicine and the the Emergency Hospital, of Yerevan, Armenia, has been developed to improve the care of the injured in that city. The Emergency Hospital, a trauma center, was site-visited by experts from a Level I trauma center who evaluated prehospital and hospital-based emergency and trauma services and made system-wide recommendations. Recognizing local limitations, the hospital was found to have the leadership commitment, staff complement, and basic infrastructure to meet the American College of Surgeons' criteria for Level II trauma centers. The goal of integration of the academic, clinical, and research roles of a medical center consistent with Level I-type trauma centers was formulated. After 36 months, several issues raised in the assessment are being addressed notwithstanding political and economic turbulence. The Emergency Hospital has established an accredited residency program in emergency medicine; implemented programs for postgraduate medical education of its staff; begun to develop medical information systems; expanded the scope of its activities to other institutions; and restructured the emergency admissions area. Management systems remain largely undeveloped as the discipline lacks recognition as an analytic tool for institutional improvement. CONCLUSIONS: The use of existing published resources for assessment and improvement of health services in dissimilar health-care systems has been validated as a systematic approach. For system advances to be well-founded, a combination of education, management, and clinical approaches needs to be addressed. Of these, our experience is that management issues are the most resistant to change.

Armenia↗

PubMedDate not supplied

Bioinformatics and genomic medicine.

Bioinformatics is a rapidly emerging field of biomedical research. A flood of large-scale genomic and postgenomic data means that many of the challenges in biomedical research are now challenges in computational science. Clinical informatics has long developed methodologies to improve biomedical research and clinical care by integrating experimental and clinical information systems. The informatics revolution in both bioinformatics and clinical informatics will eventually change the current practice of medicine, including diagnostics, therapeutics, and prognostics. Postgenome informatics, powered by high-throughput technologies and genomic-scale databases, is likely to transform our biomedical understanding forever, in much the same way that biochemistry did a generation ago. This paper describes how these technologies will impact biomedical research and clinical care, emphasizing recent advances in biochip-based functional genomics and proteomics. Basic data preprocessing with normalization and filtering, primary pattern analysis, and machine-learning algorithms are discussed. Use of integrative biochip informatics technologies, including multivariate data projection, gene-metabolic pathway mapping, automated biomolecular annotation, text mining of factual and literature databases, and the integrated management of biomolecular databases, are also discussed.

Computational Biology↗

PubMedDate not supplied

Computerized documentation for a rural nursing intervention project.

The Rural Partnership Linkage for Cancer Care project is a program of advanced practice nursing care made available to rural cancer patients to provide education, symptom management, referral, and support within their communities. The advanced practice nurses used a computerized clinical information system (CCIS) to record care. In this article the CCIS is described, the software and hardware requirements are discussed, and the outcomes and value of the system are discussed. The CCIS is a relational database run on laptop computers that includes screens for standard recording of demographics, physical exam, symptoms, and treatments. The advanced practice nurses track patient symptoms over time, noting which treatments are successful in resolving or reducing the problems. Information from patient visits is selected by help menus for inclusion into referral forms, reports of patient care, and discharge summaries. Reports can be faxed or mailed to distant sites. The research team uses the combined data set to examine symptom patterns, nursing diagnosis, and treatments that result in improved physical and psychological functioning and symptom resolution. Rural cancer patients and their families benefit from care management, participation in research, and communication of patient health status in an integrated and timely fashion made possible by the CCIS.

Community Health Nursing↗

PubMed2003

Comprehensive graphic-based display of clinical pathology laboratory data.

In this age of ever-increasing demands for and uses of patient data, technologic advancements in the form of electronic patient records permit improved data access and prompt retrieval of higher quality patient care data, with more versatility in display, facilitating the integration of information concerning patients over time and between settings of care, which is in turn more accessible for use by practitioners and provides more efficient and effective decision support in areas of patient care. The graphic display of laboratory data is central to the evolving computerized patient record and needs to be taken into careful consideration along with clinician perception and ease of data interpretation in redesigning the graphic reporting of numeric clinical pathology laboratory data. An ideal system should generate user-friendly, graphic-based comprehensive reports highlighting abnormalities with trends for diagnosis, clinical management, and risk-factor detection.

Clinical Chemistry Tests↗

PubMedDate not supplied

Building a framework to transform health care.

Advances in information technology are helping clinicians to realize the promise of evidence-based medicine, which includes benchmarking, outcomes monitoring, predictive modeling, and clinical pathways. By integrating individual clinical expertise and the best available research, physicians can apply the disciplines and techniques of clinical research to their practice of medicine, one patient at a time. Evidence-based medicine also allows organizations to move forward with continuous clinical quality improvement programs. Standards, open systems, data warehouses, and evidence-based medicine help a health care delivery system obtain the technical infrastructure, decision-making processes, analytical skills, clinical databases, predictive models, and clinical pathways. With this information technology (1) physicians can practice evidence-based medicine and (2) the delivery system can profile clinicians' practice habits for managed care contracting and continuous clinical quality improvement.

Decision Making↗

PubMed2006

Multimodal visualization interface for data management, self-learning and data presentation.

A multimodal visualization software, called the Data Manager (DM), has been developed to increase interdisciplinary communication around the topic of visualization and modeling of various aspects of the human anatomy. Numerous tools used in Radiology are integrated in the interface that runs on standard personal computers. The available tools, combined to hierarchical data management and custom layouts, allow analyzing of medical imaging data using advanced features outside radiological premises (for example, for patient review, conference presentation or tutorial preparation). The system is free, and based on an open-source software development architecture, and therefore updates of the system for custom applications are possible.

Anatomy↗

PubMed2004

Investigations of the human visual system using functional magnetic resonance imaging (FMRI).

The application of functional magnetic resonance imaging (fMRI) in studies of the visual system provided significant advancement in our understanding of the organization and functional properties of visual areas in the human cortex. Recent technological and methodological improvements allowed studies to correlate neuronal activity with visual perception and demonstrated the ability of fMRI to observe distributed neural systems and to explore modulation of neural activity during higher cognitive processes. Preliminary applications in patients with visual impairments suggest that this method provides a powerful tool for the assessment and management of brain pathologies. Recent research focuses on obtaining new information about the spatial localization, organization, functional specialization and participation in higher cognitive functions of visual cortical areas in the living human brain and in further establishment of the method as a useful clinical tool of diagnostic and prognostic significance for various pathologic processes affecting the integrity of the visual system. It is anticipated that the combined neuroimaging approach in patients with lesions and healthy controls will provide new insight on the topography and functional specialization of cortical visual areas and will further establish the clinical value of the method for improving diagnostic accuracy and treatment planning.

Brain Diseases↗

PubMedDate not supplied

Educational mobility. American Association of Colleges of Nursing.

POSITION STATEMENT: As health care shifts from a fragmented system of disparate providers and payers into integrated managed systems, nurses and other health professionals are encountering tremendous changes. The environments in which nurses practice are becoming increasingly diverse, and the skills required to practice in these settings are becoming increasingly specific to the services offered and the patients served. Advances in health-related technologies call for enhanced knowledge and application of computing and other technical skills. Nurses are faced with complex ethical dilemmas created by rationing-of-health-care decisions and research advances such as the human genome project. Practicing nurses must continue to update their skills as their work environments adapt to reforms in health care delivery. Furthermore, nurses' practice will be influenced by changes in the regulatory system that will accompany multistate recognition of licensure. Over the years, the nursing educational system, through multiple entry and exit routes, has prepared nurses for the variety of settings in which health care is delivered. The nursing educational system must continue to produce the most qualified and prepared nurses to produce the most qualified prepared nurses to deliver cost-effective and quality care. Nurse educators must continue to analyze health care trends and create flexible curricula that provide individuals with the skills and knowledge needed for diverse settings. Furthermore, nurse educators must continue to offer continuing education for nurses as they fine-tune skills for new settings. Educational mobility in nursing is the vehicle by which nurses and aspiring nurses gain new knowledge and skills through formal and informal educational offerings. Educational mobility serves the public, the profession, and the individual nurse. Educational mobility should continue to focus on promoting high standards and maintaining the quality and integrity of baccalaureate and graduate programs while emphasizing the attainment of program outcomes. The focus of higher learning should be on the socialization of students to new professional roles and the knowledge and skills needed for these roles. Educational mobility options should respect previous learning that students bring to the educational environment. To this end, educational mobility encompasses diverse approaches to continuous, life-long learning for nurses and for individuals aspiring to nursing as a profession. Baccalaureate and higher-degree programs in nursing should build on knowledge and skills attained by learners before their matriculation into formal educational programs. Higher education in nursing should be offered using creative and flexible approaches that are incorporated into curricula and reflect consideration of individual student learning needs.

Education, Nursing↗

PubMed2026

Holistic approaches for improvement of maize resistance against lodging stress: current status and future perspective.

Lodging is a major constraint in maize production, causing significant yield losses, reduced grain quality, and harvesting inefficiencies, thereby posing a serious challenge to global food security and climate-resilient agriculture. This review synthesizes current knowledge on the genetic, physiological, and agronomic determinants of maize lodging resistance and evaluates holistic strategies for improving tolerance to lodging stress. Recent advances in quantitative trait locus (QTL) mapping, genome-wide association studies (GWAS), functional gene characterization, genome editing, high-throughput phenotyping, and precision agronomy have provided powerful tools to enhance stalk biomechanics, root anchorage, and adaptive plant architecture. Integrating genomic discovery with advanced phenomics and optimized agronomic management offers a scalable framework for accelerating the development of high-yielding, lodging-resilient maize cultivars. However, critical gaps remain in understanding the genetic coordination between stalk strength and root system architecture, integrating multi-omics approaches to unravel regulatory networks, validating genome-editing interventions across diverse agro-ecologies, and developing environment-responsive predictive breeding models and cost-effective phenotyping tools, particularly for stress-prone regions. Addressing these challenges through coordinated multi-environment trials and integrative molecular-agronomic strategies will facilitate the translation of genomic discoveries into climate-resilient, high-performing maize cultivars. By consolidating molecular insights with applied breeding and management practices, this review provides a comprehensive framework that guides researchers in designing genome-informed and field-validated approaches to improve maize resistance to lodging stress and support sustainable crop production systems.

Zea mays↗