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PubMed2002

Planetree (25 years older).

"Patient-centered care" sounds like the slogan for an era in which consumers are taking more responsibility for their health care choices. In fact, it has been the foundation of the Planetree Model since 1978, when disenchantment with the hospital experience led to a philosophy that puts patients first. Twenty-five years later, Planetree-affiliated hospitals say the payoff is significant in terms of patient and staff satisfaction, and the bottom line.

Hospital Administration↗
PubMed2000

[Culture of endotheliocytes derived from guinea-pig common carotid artery and establishment of guinea-pig donor model].

Since endotheliocyte strains of guinea-pig and inbred strains of guinea-pig are not easily obtained, it is impossible to ensure the consistence of antigenicity between endotheliocytes and donor organs when endotheliocytes are used as an inductor in the research of immunological tolerance. So it is necessary to establish the guinea-pig endotheliocyte-donor model. One side of common carotid arteries was removed and reversed. After collagenase digestion, culture of endotheliocytes was performed. And the survival time of guinea-pig was observed. Cultured cells were confirmed as endotheliocytes by the study of morphology, immunohistochemistry and electron microscopy. The two-month-survival of guinea-pigs was 92% (103/112). The establishment of guinea-pig endotheliocyte-donor model can provide the foundation for the research of guinea-pig endotheliocyte and immunological tolerance.

Animals↗
PubMed2002

[Establishment of mouse ZF-12+/- embryonic stem cells].

By using the mouse zinc finger protein gene ZF-12 genomic DNA fragment, pSSC-TV-10.5 was designed and constructed as a replacement vector. Structure of pSSC-TV-10.5 was identified by restrictive digestion analysis and partly sequencing. Then linearized vector was electroporated into ES cells, and transfected cells were screened by G418 and GANC selection. Among 508 G418r/GANCr colonies, 4 were proved to have taken place the homologous recombination of ZF-12 by PCR and southern blotting analysis. This study lays the foundations of preparing mouse models of ZF-12+/- or ZF-12-/-.

Animals↗
PubMed2003

Probabilistic graphical models for computational biomedicine.

BACKGROUND: As genomics becomes increasingly relevant to medicine, medical informatics and bioinformatics are gradually converging into a larger field that we call computational biomedicine. OBJECTIVES: Developing a computational framework that is common to the different disciplines that compose computational biomedicine will be a major enabler of the further development and integration of this research domain. METHODS: Probabilistic graphical models such as Hidden Markov Models, belief networks, and missing-data models together with computational methods such as dynamic programming, Expectation-Maximization, data-augmentation Gibbs sampling, and the Metropolis-Hastings algorithm provide the tools for an integrated probabilistic approach to computational biomedicine. RESULTS AND CONCLUSIONS: We show how graphical models have already found a broad application in different fields composing computational biomedicine. We also indicate several challenges that lie at the interface between medical informatics, statistical genomics, and bioinformatics. We also argue that graphical models offer a unified framework making it possible to integrate in a statistically meaningful way multiple models ranging from the molecular level to cellular and to clinical levels. Because of their versatility and firm statistical underpinning, we assert that probabilistic graphical models can serve as the lingua franca for many computationally intensive approaches to biology and medicine. As such, graphical models should be a foundation of the curriculum of students in these fields. From such a foundation, students could then build towards specific computational methods in medical informatics, medical image analysis, statistical genetics, or bioinformatics while keeping the communication open between these areas.

Computational Biology↗
PubMed2003

Effect of off-label use of oncology drugs on pharmaceutical costs: the rituximab experience.

BACKGROUND: While the off-label use of oncology interventions is widespread, the factors influencing off-label use and the resultant influence on oncology drug expenditures are not well understood. STUDY DESIGN: To assess the indications for rituximab use, a retrospective review was undertaken at a single academic center between September 1998 and June 2001. METHODS: Patient diagnoses were linked to pharmacy records, and each administration of rituximab was classified as either on-label or off-label as defined by FDA-approved indications. The resultant utilization patterns were the foundation for a conceptual model designed to identify factors that influence off-label use of oncology-related therapeutics and forecast the effect of off-label use on aggregate oncology drug expenditures. RESULTS: One hundred one patients received a total of 428 rituximab administrations during the study period. Most (320, 75%) of the administrations were for off-label indications. Although the extent of off-label and on-label use grew at a similar rate initially, off-label utilization increased nearly exponentially over time as on-label uses lessened. A conceptual model that describes factors that promote, inhibit, or have a mixed influence on off-label use may help predict future patterns of off-label utilization and allow better forecasting of oncology drug expenditures. CONCLUSIONS: The off-label use of rituximab is substantial. Projections of oncology-related patterns of care and drug expenditures must account for the potential for off-label use.

Academic Medical Centers↗
PubMed1976

[Psychiatry and humanitarianism].

Opposing positions on mental disorder in current psychiatry, their origins and therapy are presented through a few extreme viewpoints. Considering the foundations of the 'medical model' of psychiatric disorder (Griesinger), it is evident that this model is not a closed system, but rather an open approach which still has validity today. The humanitarian roots of psychiatry prevented Griesinger from treating various positions in an absolute or ideological manner. Finally, the concept of 'illness' is discussed in relation to psychophysiological activation research. Pathology changes in each different situation and is therefore not a static phenomenon. Mental disturbance is not determined by absolute measures, but rather by a reduction in variability of reactions to the particular situation. This concept of illness can determine somato-, psycho-, and sociotherapeutic measures. Psychiatry can only remain based on humanitarian concepts as long as the sciences upon which it is founded are kept in appropriate relation to one another.

Attitude of Health Personnel↗
PubMedDate not supplied

Preoperative teaching in the preadmission clinic.

In this article, the author proposes that instructional design be used as a foundation for a teaching model in the preadmission clinic and that the educational process be based on theories developed within the fields of health care and adult education. Furthermore, the author suggests that the process of patient education, as conducted within the preadmission setting, should necessitate an assessment of the general characteristics of the adult as a learner, of the specific characteristics of the adult as a presurgical patient, and of the unique individual cognitive processes distinctive to each patient. This information should be integrated in a new framework to create a comprehensive and personalized patient teaching model.

Adult↗
PubMed2005

A portable cardiopulmonary bypass/extracorporeal membrane oxygenation system for the induction and reversal of profound hypothermia: feasibility study in a Swine model of lethal injuries.

The Cleveland Clinic Foundation's (CCF) cardiopulmonary bypass/extracorporeal membrane oxygenation (CPB/ECMO) system capabilities were tested in a hypothermia trauma management feasibility study in a porcine animal model at the Uniformed Services University of the Health Sciences (USUHS, Bethesda, MD, U.S.A.). In this survival series, the CCF system was used in a simulated forward lines combat casualty application where lethal uncontrolled hemorrhage from major vascular injuries was repaired under a state of profound hypothermic arrest (suspended animation), followed by recovery and monitoring in an intensive care unit (ICU) setting. The animals were monitored for survival, neurological impact, cognitive functions, organ damage, and delayed complications over 3 weeks. A survival rate of 83% matched rates previously found using conventional equipment. Neurological findings, organ dysfunction, and complication rates also were no different from previous studies using standard equipment. Successful survival results demonstrated that the CCF CPB/ECMO system could be used to induce a period of profound hypothermic arrest for the repair of lethal traumatic injuries. The logistical advantages of this system make it an attractive choice for use in austere settings and during transport.

Animals↗
PubMed1999

Using the business excellence model to develop a strategy for a healthcare organisation.

This article examines the appropriateness of the Business Excellence Model in developing a strategy for Bolton Hospitals NHS Trust to measure organisational performance. The need for a strategy to measure organisational performance and to improve organisational performance was highlighted with the production of the Government White Paper, The New NHS: Modern and Dependable. At the heart of recommendations there is emphasis on improving quality and driving efficiency. Greater emphasis will be placed on organisations measuring their performance. By utilising the conceptual framework, which consisted of The European Foundation for Quality Management (EFQM) Model, it became evident that, although tools were in existence within Bolton Hospitals to measure organisational performance, several critical areas needed addressing. By addressing these key areas, the organisation could begin to work towards its goal of business excellence. The conclusions drawn from this project demonstrated that there was scope for Bolton Hospitals to improve on organisational performance. It was highlighted that the Trust was functioning well in some areas of the EFQM Model, but not in others. For Bolton Hospitals NHS Trust to improve organisational performance, the EFQM Model should be adopted.

Commerce↗
PubMed2026

Non-small cell lung cancer and tumor-educated platelets: screening of biomarkers and construction of a prognostic model.

BACKGROUND: Lung cancer is a leading cause of cancer-related mortality worldwide, emphasizing the urgent need for effective early detection strategies. Traditional Chinese medicine (TCM) provides a unique perspective on tumor pathogenesis, focusing on concepts such as "long-term stasis leading to accumulation". Tumor-educated platelets (TEPs) offer potential as biomarkers due to their ability to reflect cancer heterogeneity and facilitate less invasive diagnostic approaches. This study aims to identify TEP-related prognostic biomarkers for non-small cell lung cancer (NSCLC) and to construct and validate a multigene prognostic model by integrating platelet transcriptomic data with tumor tissue datasets. METHODS: We performed comprehensive analysis of gene expression datasets obtained from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) repositories to characterize transcriptomic differences among lung cancer specimens, normal tissue samples, and TEPs. Using R software, we identified Differentially expressed genes (DEGs) and subsequently applied a multi-stage analytical pipeline to TEP-associated DEGs, incorporating univariate Cox proportional hazards regression, least absolute shrinkage and selection operator (LASSO) regression, multivariate Cox regression, and stepwise regression modeling to pinpoint genes with prognostic significance. These prognostically relevant genes served as the foundation for developing a risk stratification model. We computed individual risk scores across both training and validation cohorts, enabling patient stratification into high- and low-risk categories. Model robustness was assessed through internal cross-validation and external validation procedures, while predictive performance was quantified using risk calibration metrics and receiver operating characteristic (ROC) curve analysis. RESULTS: Through systematic bioinformatics screening, we identified a four-gene prognostic signature comprising NELL2, C4orf48, PRAM1, and KLHL35, which served as the foundation for developing our risk stratification algorithm. Rigorous internal cross-validation and external cohort validation substantiated the moderate predictive performance of this signature. Comprehensive clinicopathological correlation analysis revealed that elevated risk indices, advanced pathological staging (stage III-IV), increased primary tumor dimensions, regional lymph node metastasis, and distant organ dissemination each demonstrated statistically significant associations with diminished overall survival (OS) outcomes in lung cancer patients. The clinical nomogram exhibited acceptable calibration, with calibration plots showing reasonable concordance between predicted and observed survival probabilities across all time points. Discriminative capacity assessment via time-dependent ROC analysis yielded area under the curve (AUC) values consistently surpassing 0.6, confirming moderate prognostic discrimination. Furthermore, decision curve analysis (DCA) demonstrated that our integrated multi-gene model conferred potential net clinical benefit compared to individual prognostic variables across the full spectrum of clinically relevant threshold probabilities (0-1 range), thereby establishing its potential utility for risk-informed clinical decision-making. CONCLUSIONS: This study identified NELL2, C4orf48, PRAM1, and KLHL35 as candidate TEP-related prognostic biomarkers for non-small cell lung cancer (NSCLC). The developed prognostic model shows preliminary potential for patient stratification, but its clinical application, particularly as a platelet-based liquid biopsy tool, requires further validation in independent TEP-based cohorts.

Tumor-educated platelets (TEPs)↗
PubMed2004

Effects of cardiopulmonary bypass on sufentanil pharmacokinetics in patients undergoing coronary artery bypass surgery.

BACKGROUND: Complete pharmacokinetic modeling, including assessment of the effect of cardiopulmonary bypass (CPB) on sufentanil disposition, has not been reported. The aims of this investigation were to define a model that accurately predicted sufentanil concentrations during and after cardiac surgery and to determine if CPB had a clinically significant impact on sufentanil pharmacokinetics. METHODS: Population pharmacokinetic modeling was applied to data from 21 patients undergoing coronary artery bypass grafting. The predictive ability of models was assessed by calculating bias, accuracy, and measured:predicted concentration ratios versus time. A simple three-compartment model, without covariates, was initially compared with models having weight or gender as covariates and was subsequently used as the foundation for multiple CPB-adjusted models (allowing step-changes of parameters at the start or end of CPB). The primary criterion for choosing more complex models was a significant improvement in log-likelihood; secondary criteria were significant improvement in bias or accuracy. RESULTS: Neither covariate (weight or gender) models improved bias or accuracy compared with the simple three-compartment model. A final CPB-adjusted model with V2 and Cl3 changing at the start of CPB and V1, Cl2, and Cl3 changing at the end of CPB had significantly greater log-likelihood values when compared with the simple three-compartment model and with less elaborate CPB-adjusted models. However, bias and accuracy for this final model were not significantly different from the simple three-compartment model. CONCLUSIONS: When sufentanil is infused at a constant rate, with initiation of CPB, a pharmacokinetic model adjusted for CPB predicts that the sufentanil concentration will decrease approximately 17% and that it will begin to return to the prebypass concentration 12 min after initiation of CPB. At the end of CPB, this model also predicts a brief spike of the sufentanil concentration. These predictions reflect changes in the measured sufentanil concentrations. However, compared with a simple, three-compartment model, incorporating step-changes of pharmacokinetic parameters at the start or end of cardiopulmonary bypass (or both) did not significantly improve overall perioperative prediction of measured sufentanil concentrations. This suggests that CPB has clinically insignificant effects on sufentanil kinetics in adults.

Aged↗
PubMed1999

[Experimental hepatocarcinogenesis--evaluation of the significance of experimental modeling. Classical models].

There are an increasing number of models for the study of liver cancer development with such agents as chemicals, hormones, and viruses. This process is almost always a multistep and during the long period of cancer development, discrete cells or cell populations acquire step-by-step the various properties that go to make up a cancer. The hepatocarcinogenesis models are useful in identification and analysis of the preneoplastic and neoplastic alterations, as well HCC. This article presents a review of theoretical foundation and mechanisms of various models of experimental hepatocarcinogenesis as well contain a short presentation of animals practical in those experiments, principally rats. The remarkable similarities between many models with different carcinogens in animals and humans suggest the importance of such studies in understanding of molecular basis of liver cancer development.

Animals↗
PubMed2000

[Experimental hepatocarcinogenesis--evaluation of the significance of theoretical models. Contemporary models].

There are an increasing number of models for the study of liver cancer development with such agents as chemicals, hormones, and viruses. This process is almost always a multistep and during the long period of cancer development, discrete cells or cell populations acquire step-by step the various properties that go to make up a cancer. The hepatocarcinogenesis models are useful in identification and analysis of the preneoplastic and neoplastic alterations, as well HCC. This article presents a review of theoretical foundation and mechanisms of various models of experimental hepatocarcinogenesis as well contain a short presentation of animals practical in those experiments, principally rats. The remarkable similarities between many models with different carcinogens in animals and humans suggest the importance of such studies in understanding of molecular basis of liver cancer development.

Animals↗
PubMedDate not supplied

A case report: special needs of hospitalized elders.

A case report is used to discuss common problems and complications of hospitalized elders. The report also illustrates the need for proactive hospital staff who are knowledgeable about the special needs of the aging population if this group is to be cared for successfully. The geriatric resource nurse model involves informal unit-based education aimed at expanding staff nurses' geriatric knowledge and is one of several models sponsored by the Hartford Foundation to improve care of the hospitalized elderly. Teaching rounds between geriatric resource nurses and advanced practice nurses are a primary feature of this model.

Aged↗