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PubMed2000

Learning to care for clients in their world, not mine.

Current literature and trends support the need to incorporate concepts for culturally focused nursing care and experiences with diverse cultures into nursing curricula. The purposes of this qualitative research were to describe the phenomena of being immersed in a different culture and to generate a conceptual map depicting process and outcomes of the immersion experience. From analysis of stories told by practicing nurses (n=9) who had an immersion experience during a baccalaureate program, a dimensional matrix emerged. The core dimension was learning to care. Situational predetermining factors included educational setting, personal characteristics, and demographic factors. Characteristics of the immersion context were site conditions. Transitional factors included strategies for "learning to care" such as social support, coping responses, and openness to adapt communication patterns. Outcomes included personal and professional growth in values, communication, and nursing practice. The matrix can guide nurse educators in incorporating immersion experiences into nursing curricula.

Acculturation↗
PubMed1995

Functional magnetic resonance imaging of the brain.

This conference reviewed the potential scope of application of recently developed techniques for functional magnetic resonance imaging (fMRI) of the brain. The most successful technique is based on the sensitivity of magnetic resonance imaging (MRI) to magnetic effects caused by the modulation of the oxygenation state of hemoglobin, which is induced by local variations in blood flow during task activation. Typically, the MRI signal increases by a few percentage points during brain activation because blood flow and oxygen supply sharply increase. Brain activation images with excellent combined spatial and temporal resolution have been obtained noninvasively using visual, sensorimotor, or auditory stimuli, or during higher-order cognitive processes such as language or mental imagery. Although sensitive to misregistration artifacts and macroscopic vessels, MRI permits both the direct correlation of function with underlying anatomy and repeated studies on the same person. It may become the method of choice for studies of mental and cognitive processes, presurgical mapping, monitoring recovery from stroke or head injuries, exploration of seizure disorders, or monitoring the effects of neuropharmaceuticals.

Animals↗
PubMed2001

SNOMED clinical terms: overview of the development process and project status.

Two large health care reference terminologies, SNOMED RT and Clinical Terms Version 3 , are in the process of being merged to form a comprehensive new work referred to as SNOMED Clinical Terms. The College of American Pathologists and the United Kingdom s National Health Service have entered into a collaborative agreement to develop this new work. Both organizations have extensive terminology development and maintenance experience. This paper discusses the process and status of SNOMED CT development and how the resources and expertise of both organizations are being used to develop this new terminological resource. The preliminary results of the merger process, including mapping, the merger of upper levels of each hierarchy, and attribute harmonization are also discussed.

Clinical Medicine↗
PubMed2002

New approach to behavior change geared toward individual practitioners.

That is the prescription of at least one expert who contends that common practitioner behaviors actually build up resistance to change in their chronically ill patients. To combat these behaviors, he contends that many practitioners need to learn new skills to help them better guide patients along the continuum of change. In fact, he has developed a road map or process that he says can turn what he calls "fix it" practitioners into "motivational" practitioners.

Chronic Disease↗
PubMed2003

Cell type-specific circuits of cortical layer IV spiny neurons.

Sensory signal processing in cortical layer IV involves two major morphological classes of excitatory neurons: spiny stellate and pyramidal cells. It is essentially unknown how these two cell types are integrated into intracortical networks and whether they play different roles in cortical signal processing. We mapped their cell-specific intracortical afferents in rat somatosensory cortex through a combination of whole-cell patch-clamp recordings and caged glutamate photolysis. Spiny stellate cells received monosynaptic excitation and inhibition originating almost exclusively from neurons located within the same barrel. Pyramidal cells, by contrast, displayed additional excitatory inputs from nongranular layers and from neighboring barrels. Their inhibitory inputs originated, as for spiny stellate cells, mainly from neurons located in the same barrel. These results indicate that spiny stellate cells act predominantly as local signal processors within a single barrel, whereas pyramidal cells globally integrate horizontal and top-down information within a functional column and between neighboring barrels.

Afferent Pathways↗
PubMed2004

A technique for standardized central analysis of 6-(18)F-fluoro-L-DOPA PET data from a multicenter study.

UNLABELLED: We have recently completed a large 6-(18)F-fluoro-L-DOPA ((18)F-DOPA) PET study comparing rates of loss of dopamine terminal function in Parkinson's disease (PD) patients taking either the dopamine agonist ropinirole or L-DOPA. This trial involved a "distributed acquisition/centralized analysis" method, in which (18)F-DOPA images were acquired at 6 different PET centers around the world and then analyzed at a single site. To our knowledge, this is the first time such a centralized approach has been employed with (18)F-DOPA PET and this descriptive basic science article outlines the methods used. METHODS: One hundred eighty-six PD patients were randomized (1:1) to ropinirole or L-DOPA therapy, and (18)F-DOPA PET was performed at baseline and again at 2 y. The primary outcome measure was the percentage change in putamen (18)F-DOPA influx rate constant (K(i)) from Patlak graphical analysis. Dynamic images were acquired and reconstructed using each center's individual protocols before being transferred to the site performing the central analysis. Once there, individual parametric K(i) images were created using a single analysis program without file formats being transformed from the original. Parametric images were then normalized to standard space and K(i) values extracted with a region of interest analysis. Significant K(i) changes were also localized at a voxel level with statistical parametric mapping. These processes required numerous checks to ensure the integrity of each dataset. RESULTS: Three hundred twenty-five (170 baseline, 155 follow-up) dynamic PET datasets were acquired, of which 12 were considered uninterpretable due to missing time frames, radiopharmaceutical problems, lack of measured attenuation correction, or excessive head movement. In those datasets suitable for central analysis, after quality control and spatial normalization of the images had been applied, putamen (18)F-DOPA signal decline was found to be significantly (one third) slower in the ropinirole group compared with that of the L-DOPA group. CONCLUSION: Paired (18)F-DOPA-PET images acquired from multiple sites can be successfully analyzed centrally to assess the efficacy of potential disease-modifying therapies in PD. However, numerous options must be considered and data checks put in place before adopting such an approach. Centralized analysis offers the potential for improved detection of outcomes due to the standardization of the analytic approach and allows the analysis of large numbers of PET studies.

Algorithms↗
PubMed2004

More dollars and more smiles.

Healthcare organizations can enhance customer satisfaction by identifying problem points along the revenue cycle and using key performance metrics to resolve those issues. They can establish metrics for revenue-cycle customer satisfaction by: Mapping the process to identify touch points. Confirming touch points and asking employees for their perceptions. Talking to patients and families. Conducting research.

Consumer Behavior↗
PubMedDate not supplied

Lean Management and Six-Sigma yield big gains in hospital's immediate response laboratory. Quality improvement techniques save more than $400,000.

DSI Laboratories has used Lean and Six-Sigma methodologies to systematically eliminate waste and reduce variation in its hospital clinical laboratory. The net result was a savings of more than $400,000 in the first year. After mapping its process, the laboratory found that phlebotomists were submitting samples in large batches, which created an early-morning flood of specimens. Switching to single-piece workflow and distributing the workload more evenly allowed DSI to cover the same number of patients with two to three phlebotomists instead of 12. By establishing a more efficient workflow process within the laboratory, a single technologist could quickly move between stations and perform those tests that made up 80% of the work volume. New inventory management techniques reduced both excess inventory and the risk of shortages. Cost savings for the first year were: Reduced overtime spending by 60% ($78,000), Reassigned six phlebotomists for an annual savings of $160,000, 4.5 fewer technologist positions for a savings of $250,000.

Cost Savings↗
PubMed1992

Courage and curiosity: surgeon-explorers in Australia and New Zealand. Part II. The science of the outback. The Herbert Moran Lecture concluded.

After the broad brush of the topographical features of Australia and New Zealand had been mapped, the process of fine-tuning the geographic details of these countries continued. In parallel with this, a great wave of detailed scientific exploration proceeded and it was to these expeditions that medical men brought special skills. Surgeons played a special role because of the need of their practical skills in the field. Dozens of expeditions were commissioned throughout the nineteenth century. The aim of some was to search for minerals and document the fertility and water supply for pastoral and agricultural lands. Others had as their major raison d'etre the documentation of the many groups of animals and plants which populated these domains new to Western science. Surgeons and physicians were valued not only for their professional skills in the field, but for the pursuit of botany, zoology and geology, and in many cases for ethnological studies as well.

Anthropology↗
PubMed2005

Aging-associated loci in Canis familiaris.

Although recent endeavors to discover the mechanisms of the aging process have been numerous and successful, there is still much to be learned. Genes implicated in the aging process were mapped to the canine genome and will serve as additional framework markers for the assignment of contiguous segments from the canine genome sequence to chromosomes. The 54 genes were selected because of their demonstrated contribution to longevity in other organisms or based upon their proximity to a marker, D4S1564, on human chromosome 4 (Puca et al., 2001). This effort lays the necessary groundwork for our utilization of the domestic dog as a model organism to define the genes that govern aging and longevity. Within the species, naturally diverse life expectancies and highly homogeneous populations create an ideal population structure for studying the genetic components of aging (Patronek et al., 1997).

Aging↗
PubMed2006

A method for specification of structured clinical content in electronic health records.

The Copenhagen County is using clinical guidelines in the electronic health record development to provide documentation support, process support and decision support for the healthcare professionals. The electronic health record development is based on three main components: The first component is a national information model. The second component is a common classification system (SNOMED). The third key component is the so-called "clinical content". This paper describes the structured "clinical content", how it is linked to the clinical process, and how it is used to create clinical guidelines in the form of standard care plans. The Copenhagen County and MEDIQ has developed a methodology for identifying and specifying structured "clinical content" to be used in electronic health records. The method combines analyses of national clinical guidelines with local experience and practices and it heavily involves healthcare professionals. The method includes four main steps: Analyses of background material, analyses of clinical process-flow, mapping to standards (the national information model and the common classification system), and specification of the structured clinical content itself. Three secondary steps may be added to specify the clinical content in more detail: Workflow analyses, analyses of quality indicators, and decision analyses. This paper reports the experiences using the method and stresses the demand for a common exchange format and IT-tools for documenting clinical content in a formalised way.

Decision Support Systems, Clinical↗
PubMed1991

Effect of physiological and pathological aging processes on topographic bit-mapped cognitive evoked potentials in presenile subjects.

Bit-mapped multicomponent CNV complex and reaction time (RT) were recorded and measured in 24 presenile patients with initial symptoms of very mild to moderately severe primary mental deterioration without depression, and in 10 age-matched controls. All patients underwent CT and MRI examinations, EEG spectral analysis and a battery of psychometric test. Significant group differences were obtained for measures of some post-S1 ERP and CNV components, particularly of the post-S1 N1b, P300 and early and late pre-S2 CNV. P300 with increased latency, no significant CNV activity, very prolonged RTs, EEG slowing down and diffuse brain atrophy were observed in the majority of patients with probable presenile Alzheimer's dementia. These results suggest that CNV/RT and EEG activity changes similar to those observed in our patients may constitute a valuable clue for the study of brain dysfunction in the early stage of presenile idiopathic cognitive impairment.

Aged↗
PubMed1988

A rhythmically discharging neuron in the earthworm ventral cord nerve as identified by lucifer yellow-CH injection.

In the process of mapping the ganglionic neurons in the earthworm ventral nerve cord by simultaneous recording and Lucifer Yellow-CH injection or by backfilling, a rhythmically discharging neuron with a continuous train of 100 cps over the entire recording period was encountered at the dorsal side of the cord near the base of the 2nd-3rd nerves, with its axon extending toward the 2nd-3rd contralateral nerves. It could not be determined whether branches of this axon entered these contralateral nerves. The rhythmic discharge could not be recorded extracellularly from the nerves or from the cord by suction or hook electrodes, nor did the cell respond to either intra- or extracellular stimulation through the recording and injection microelectrode. Although contralateral neurons have been described in histological works, this neuron may not be identifiable one of them until its relationship with other neurons becomes clear.

Animals↗
PubMed1980

Detection of enzootic territories and exploration of tularemia epizootics in different types of natural foci of this infection by serological examination of bird pellets and the excrements of beasts of prey.

Serological analysis (reaction of antibody neutralization) of pellets of birds and excrements of beasts of prey for the presence of tularemia microbe antigen is an efficient method of detection and investigation of epizootics in all types of natural foci of the infection and also for the exploration of new focal territories. The method permits with small expenditure of labour and within a short time, to collect material characterizing the epizootic process on a large territory. Tularemia epizootics, both having taken place in the past and ruinning at the moment of observation, are detected. It is possible to carry out the observations even in the years of a reduced number of the main carriers of the agent of tularemia and thus to trace the continuity of the epizootic process. The obtained data permit to establish the essential characteristics of the epizootic process. Detailed maps of the foci can be drawn and territories of stable preservation of infection detected.

Animals↗
PubMed1996

The effect of textual variation on concept based information retrieval.

Accounting for textual variation in the documents and queries processed by information retrieval systems is considered essential for achieving good retrieval. Recent research has called into question several of the techniques used to support this endeavor. This paper reports on experiments with a concept based information retrieval system which relies on a program called MetaMap to account for textual variation in the process of mapping biomedical text such as MEDLINE bibliographic citations to the UMLS Metathesaurus. The experiments confirm that the effort expended in handling textual variation is well-spent for at least one type of concept based information retrieval.

Information Storage and Retrieval↗
PubMed2006

Using recurrence quantification analysis determinism for noise removal in cardiac optical mapping.

Selecting signal processing parameters in optical imaging by utilizing the change in Determinism, a measure introduced in Recurrence Quantification Analysis, provides a novel method using the change in residual noise Determinism for improving noise quantification and removal across signals exhibiting disparate underlying tissue pathologies. The method illustrates an improved process for selecting filtering parameters and how using measured signal-to-noise ratio alone can lead to improper parameter selection.

Algorithms↗
PubMed1993

EEG- and EP-mapping--possible indicators for disturbed information processing in schizophrenia?

1. Schizophrenic patients have been investigated electroencephalographically to describe disturbed information processing mechanisms. 2. 16-channel quantitative EEG and P300 were recorded at resting conditions before and during neuroleptic depot injection. 3. Reduced occipital alpha-power and alpha-power dependent P300-amplitudes were found in the schizophrenics. 4. Hippocampal structures are involved in the disturbed information processing mechanisms.

Adult↗