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PubMedDate not supplied

Addressing organizational issues into the evaluation of medical systems.

New system design and evaluation methodologies are being developed to address social, organizational, political, and other non-technological issues in medical informatics. This paper describes a social interactionist framework for researching these kinds of organizational issues, based on research within medical informatics and other disciplines over the past 20 years. It discusses how effective evaluation strategies may be undertaken to address organizational issues concerning computer information systems in medicine and health care. The paper begins with a theoretical framework for evaluation. It then describes the 4Cs of evaluation: communication, care, control, and context. Five methodological guidelines are given for conducting comprehensive evaluations that address these 4Cs. An example of an evaluation research design that fits the guidelines and was used in an evaluation of an on-line clinical imaging system is discussed. Results of the evaluation study illustrate how this approach addresses organizational concerns and the 4Cs.

Communication↗
PubMed2001

Addressing multiple problems in the family practice office visit.

OBJECTIVES: The purpose of the study was to describe the number of problems addressed during family practice outpatient visits, the nature of additional problems raised, how they affect the duration of the visit, and how well they are reflected in the billing record. STUDY DESIGN: Cross-sectional. POPULATION: We studied a total 266 randomly selected adult patient encounters representing 37 physicians. OUTCOMES MEASURED: A problem was defined as an issue requiring physician action in the form of a decision, diagnosis, treatment, or monitoring. Visit duration and the number of billing diagnoses were also assessed. RESULTS: On average, 2.7 problems and 8 physician actions were observed during an encounter. More than one problem was addressed during 73% of the encounters; 36% of these additional problems were raised by the physician and 58% by the patient. On average, each additional problem increased the length of the visit by 2.5 minutes (P<.001). The concordance between the number of problems observed and the number of problems on the billing sheet indicated a trend toward underbilling the number of problems addressed. CONCLUSIONS: Multiple problems are commonly addressed during family practice outpatient visits and are raised by both the physicians and the patients. Our findings suggest that current views of physician productivity and the billing record are poor indicators of the reality of providing primary care.

Adult↗
PubMed2001

How to address patient complaints.

All patient complaints should be addressed appropriately, with the goal of improving care and boosting patient satisfaction. Address complaints immediately, while the patient is still in the ED. If a complaint is about quality of care, have the patient speak to an individual who can address both medical and risk management issues. Have a policy to address complaints. Make verbal contact with every patient who complains.

Efficiency, Organizational↗
PubMed1990

[The use of RNAse H for digestion of alkylated 16S rRNA at the binding sites of addressed reagents--oligodeoxyribonucleotide derivatives].

It is demonstrated that 16S rRNA, complementary-addressed labelled with 2',3'-O-[4-N-methyl-N-(2-chloroethyl)-amino]benzylidene derivatives of oligonucleotides d(pACCTTGTT)rA and d(pTTTGCTCCCC)rA, can be cleaved by RNase H within the adducts, resulted from the modification. Comparative study of the 16S rRNA cleavage with RNase H within the above--mentioned covalent adducts, on the one hand, and within heteroduplexes with the same oligodeoxyribonucleotides, on the other, showed that(i) the complementary-addressed modification proceeds both in perfect and non-per ect complexes; (ii) 16S rRNA is cleaved by RNase H within both perfect and non-perfect complexes resulted from the alkylation, non-perfect complexes being considerably stabilized by the covalent bond between the reagent and the RNA; (iii) non-perfect complexes of 16S rRNA with the free oligodeoxyribonucleotides are unstable even at the high oligonucleotide concentration, so that no cleavage of 16S rRNA in such duplexes is observed. The approach based on cleavage of RNA within covalent adducts resulted from the complementary-addressed RNA modification may be used for fragmentation of RNA molecule in the addressed reagent's binding site.

Alkylation↗
PubMed1995

In search of effective programs to address students' emotional distress and behavioral problems. Part I: Defining the problem.

This article discusses the prevalence and seriousness of emotional difficulties and behavioral problems in students, with a special focus on high school students and the obstacles they encounter when addressing these problems. The educational, psychological, and medical literature which addressed the problem over the past five years was evaluated, and 22 references were selected. It was determined that the lack of consensus on the terms used to describe the problem prevented accurate assessment of its prevalence. However, one fifth to one third of the students were found to be affected, leading to serious educational, psychosocial, and economic difficulties--and more are likely to be affected in the 1990s. Since the school and mental health systems have not been entirely successful in addressing the problem, adolescents' patterns of seeking help indicate that peer support groups can be part of the solution. It was concluded that the enormity of the problem requires a low-cost gate-keeping mechanism to facilitate early identification and intervention. Thus, school peer-support programs, if proven effective, may complement traditional mental health services in addressing adolescents' emotional distress and behavioral problems.

Adolescent↗
PubMed1996

Solution structure of regioselectively addressable functionalized templates: an NMR and restrained molecular dynamics investigation.

Three cyclic peptides that are Regioselectively Addressable Functionalized Templates (RAFT) for use in protein de novo design have been investigated using a combination of nmr, restrained molecular dynamics, and CD spectroscopy. These peptides contain up to four selectively addressable sites (orthogonally protected lysine side chains) or have selectively addressable faces. The results show a common stable conformation for templates of this kind based on two type II beta-turns and an associated beta-sheet structure. A preferential orientation for the side chains is also demonstrated. The significance of these findings is discussed in the context of applications of RAFT that rely on their conformational rigidity and ability to present functionalities in a defined spatial arrangement.

Amino Acid Sequence↗
PubMed2001

Playing it safe: addressing the emotional and physical health of lesbian and gay pupils in the U.K.

Compared to young people in general, young lesbians and gay men can face specific challenges to their physical and emotional well-being. These include discrimination, victimization, homophobic bullying and an elevated suicide risk. Relative to initiatives which attempt to address bullying in general, little has been done in schools in the U.K. to address physical and verbal homophobic bullying. This paper reports on an exploratory study to examine teachers' perceptions of homophobic bullying, the responses made to this form of bullying, and the factors which impact on the provision of education and support to lesbian and gay pupils. Findings suggested that teachers were aware of homophobic bullying but were confused, unable or unwilling to address the needs of lesbian and gay pupils. Implications for policy, practice and research are discussed. While current U.K. Government policy promoting Healthy Schools and Citizenship education offers hope for the future, much remains to be done to ensure that such initiatives are inclusive of all pupils.

Female↗
PubMed1991

Dermenkephalin and deltorphin I reveal similarities within ligand-binding domains of mu- and delta-opioid receptors and an additional address subsite on the delta-receptor.

Dermorphin (Tyr-D-Ala-Phe-Gly-Tyr-Pro-Ser-NH2), dermenkephalin (Tyr-D-Met-Phe-His-Leu-Met-Asp-NH2) and deltorphin I (Tyr-D-Ala-Phe-Asp-Val-Val-Gly-NH2) are the first naturally occurring peptides highly potent for and almost specific to the mu- and delta-opioid receptors, respectively. The amino-terminal domains Tyr-D-X-Phe (where X is either Ala or Met) of these peptides behave as selective and potent mu-receptor ligands. Routing of Tyr-D-X-Phe to the delta- or the mu- receptor is associated with the presence or the absence at the C-terminus of an additional hydrophobic and negatively charged tetrapeptide by-passing the mu-addressing ability of the amino-terminal moiety. A study of 20 Tyr-D-X-Phe-Y-NH2 analogs with substitution of X and Y by neutral, hydrophobic, aromatic amino acids as well as by charged amino acid residues shows that tetrapeptides maintain high binding affinity and selectivity for the mu-opioid receptor. Although residue in position 4 serves a delta-address function, the tripeptide motif at the C-terminus of dermenkephalin and deltorphin I are critical components for high selectivity at delta-opioid receptor. Results demonstrate that mu- and delta-opioid receptors share topologically equivalent ligand-binding domains, or ligand-binding sequences similarities, that recognized Tyr-D-X-Phe as a consensus message-binding sequence. The delta-receptor additionally contains a unique address subsite at or near the conserved binding domain that accommodates the C-terminal tetrapeptide motif of dermenkephalin and deltorphin I.

Amino Acid Sequence↗
PubMed1990

Fate of incorrectly addressed mailed questionnaires.

Mail surveys are a widely used and often inexpensive method for conducting epidemiologic studies, but may suffer from poor response rates. Some of this nonresponse may be due to letters that never reach study subjects rather than nonparticipation. We mailed letters to invalid addresses and to fictitious occupants at valid addresses in order to determine the proportion of letters that were not returned to us by the postal service as undeliverable. All letters mailed to invalid addresses were returned, whereas 13.3% (95% Cl 2.0-24.7%) of letters sent to fictitious occupants were not. Because some undeliverable mail is not returned, investigators may erroneously assume nonresponse for some subjects who never have the opportunity to participate.

Epidemiologic Methods↗
PubMed1998

Obstacles to addressing professional misconduct.

The Ethical Principles exhort psychologists "to encourage ethical behavior by students, supervisees, employees, and colleagues, as appropriate" (American Psychological Association, 1992, p. 1599). In spite of a clear directive to attempt resolution of unethical conduct by colleagues, research indicates that satisfactory resolution or actual reporting of misconduct is infrequent. This paper will address some of the forces that discourage psychologists from dealing responsibly and appropriately with professional misconduct by colleagues. The goals of this paper are to promote understanding of factors that interfere with the effective resolution of ethical misconduct, to identify possible signs of reluctance to address misconduct, and to propose strategies to combat those forces that keep us in silent collusion with colleagues who engage in unethical practices. A flowchart of steps for addressing possible misconduct by a colleague is provided, and educational, organizational, and professional considerations are discussed.

Awareness↗
PubMed2001

Electrical properties of a light-addressable microelectrode chip with high electrode density for extracellular stimulation and recording of excitable cells.

A light-addressable microelectrode chip with 3600 TiN electrodes was fabricated. Amorphous silicon (a-Si:H) serves as a photo conductor. The electrodes on the chip are addressed by a laser spot and electrical properties of the system are determined. DC measurements show a dark to bright dynamic of 10(6)-10(7). The AC impedance dynamic @ 1 kHz/100 mV and thus the signal-to-noise-ratio is determined to 60. This value is quite sufficient for electrophysiological measurements. For the first time, recordings from cardiac myocytes are reported using the principle of light-addressing. Measurements were done with a standard laser scan microscope (Zeiss LSM 410).

Electric Stimulation↗
PubMed2000

The AMA clinical quality improvement forum on addressing patient safety.

BACKGROUND: More than 200 health care policy makers and researchers, clinicians, quality professionals, and other representatives of health care organizations, government, and academia attended the Division of American Medical Association Clinical Quality Improvement's conference, "Addressing Patient Safety," April 28, 2000, in Chicago--the first national conference to respond to the recent Institute of Medicine (IOM) report, To Err Is Human: Building a Safer Health System. ADDRESSING PATIENT SAFETY--PUBLIC AND PRIVATE PERSPECTIVES: John M. Eisenberg, MD, stated that research on errors is needed to describe the scope and nature of the problem, understand the barriers to and benefits of improvement, and develop and test strategies for improvement. Kenneth W. Kizer, MD, MPH, stated that the National Quality Forum will develop a compendium of best practices and will develop core measures for serious adverse events, and health care organizations and government health programs should act now to make a clear organizational commitment to patient safety, create a nonpunitive health care culture of safety, and implement known safe medication practices. Alan R. Nelson, MD, stated that the IOM report places its emphasis on continuous quality improvement and technology that can be used to mitigate the risks in a complex health system. HOSPITAL AND ACCREDITATION AGENCY ACTIVITIES ON PATIENT SAFETY ISSUES: Donald M. Nielsen, MD, discussed the American Hospital Association's (AHA's) Medication Safety Initiative, which promised to provide its members with successful practices, tools, and resources and to track progress of implementation of the recommended successful practices. Dennis S. O'Leary, MD, stated that when a hospital reports a sentinel event, the hospital is expected to implement improvements to reduce risk and monitor their effectiveness. The National Committee for Quality Assurance is considering changes to its accreditation standards to further address patient safety.

Accreditation↗
PubMed1997

Discovery of a novel class of substituted pyrrolooctahydroisoquinolines as potent and selective delta opioid agonists, based on an extension of the message-address concept.

This paper describes the design and synthesis of compounds belonging to a novel class of substituted pyrrolooctahydroisoquinolines which are potent and selective delta opioid agonists. Molecular modeling studies performed on known, selective delta ligands such as (+)-3 and the potent delta agonists SNC 80 led to the identification of the carboxamido moiety of the latter as a putative nonaromatic delta address. Insertion of this moiety onto the octahydroisoquinoline opioid message resulted in (+/-)-5b, a potent and selective delta ligand. The active enantiomer, (-)-5b, displayed nanomolar affinity for the delta receptor (Ki = 0.9 nM) with good mu/delta and kappa/delta binding selectivity ratios (140 and 1480, respectively). In addition, (-)-5b behaved as a full delta agonist in the mouse vas deferens bioassay having an IC50 = 25 nM and being antagonised in the presence of 30 nM naltrindole (NTI). These studies, based on the message-address concept, indicated that the nonaromatic (N,N-diethylamino)carbonyl moiety is a viable alternative to the classical benzene ring as a delta opioid address. Preliminary in vivo studies showed that (+/-)-5b produced a dose-related antinociception in the mouse abdominal constriction test after intracerebroventricular administration (ED50 = 1.6 micrograms/mouse).

Animals↗
PubMed1988

Theoretical analysis of 'addressed' chemical modification of DNA.

Chemical "addressed" modification of DNA involves treatment of single-stranded DNA with oligonucleotides complementary to certain target sequences in this DNA and bearing a groupings reactive towards DNA bases. The binding of oligonucleotides can occur both at completely (specific) and incompletely (nonspecific) complementary sites. We analyse the modification of a fragment that is flanked by two target sequences complementary to a given oligonucleotide address, contains no more such targets and has some randomly distributed sites for nonspecific binding. Conditions for the maximum ratio between specific and non-specific modification are determined. We find the probability of both target termini being specifically modified without any non-specific modification occurring within the fragment up to a given moment in time. Quantitative analysis is based on the use of known features of the specific and non-specific binding of an oligonucleotide to DNA sites. This analysis shows the possibility of specific cutting of DNA based on addressed modification.

Base Composition↗
PubMed1987

Digital waveform generation by fractional addressing.

This article concerns the generation of waveforms by a digital oscillator in which sampled data in a memory buffer are recycled. The buffer contains a fixed waveform and the output sample rate is also fixed. Despite these constraints, the oscillator is capable of arbitrarily high frequency resolution if the technique of fractional addressing is used. However, fractional addressing introduces distortion. This article gives a theory of fractional addressing, resembling the theory of diffraction in crystal lattices with a basis. The theory shows how the spectrum of the distortion components can be calculated and how the distortion can be minimized. Attention is called to numerous symmetries in the distortion spectrum. These symmetries are especially interesting if the purpose of the system is to make use of the distortion components to create inharmonic signals. Of particular importance is the gamma p symmetry theorem, which makes it possible to derive simple formulas for the level of the largest distortion component and for the total distortion power.

Acoustics↗
PubMed1985

Therapist actions that address initially poor therapeutic alliances in psychotherapy.

The authors studied six patients treated in time-limited dynamic psychotherapy who had initially poor therapeutic alliance scores; three patients went on to have improved alliances and good outcomes, and three had unimproved alliances and poor outcomes. The therapist actions that most strongly differentiated the two groups and occurred more frequently in the cases with improved alliances and good outcomes were 1) addressing the patient's defenses, 2) addressing the patient's guilt and expectation of punishment, 3) addressing the patient's problematic feelings in relation to the therapist, and 4) linking the problematic feelings in relation to the therapist with the patient's defenses.

Adjustment Disorders↗
PubMed1997

Psychiatrists and their patients: views on forms of dress and address.

BACKGROUND: Dress styles and forms of address vary among psychiatrists. METHOD: A semi-structured interview was administered to a sample of psychiatric in-patients, and a questionnaire was sent to junior and consultant psychiatrists, to identify preferences for dress styles and terms of address. RESULTS: Forty-nine (71%) of the in-patient sample participated. A preference was found for smart attire and white coats. Of the 69 (80%) doctors returning questionnaires, the majority supported smart dress as the most appropriate attire. Most patients preferred to be called by their first name while addressing doctors by title and surname. Junior doctors preferred to use first names when talking to patients while almost all consultants used title and surname. Doctors of all grades liked to be called by their title and surname. CONCLUSIONS: Paying more attention to the way we present ourselves and interact at work may help to facilitate the therapeutic alliance.

Adolescent↗
PubMed1999

What are animal science departments doing to address contemporary issues?

Animal science departments are principle progenitors and disseminators of scientific information relating to the production of agricultural animals and their food products. The Land-Grant university missions of teaching, research, and extension are conduits designed to advance and enhance scientific knowledge within agriculture and to make this knowledge available to the public. I conducted an electronic survey to determine whether animal science departments are addressing contemporary issues through the traditional missions of the Land-Grant university system, which issues they are addressing, and how they are addressing these issues. Sixty-three animal science department administrative heads (AH) were contacted through an E-mail listserve maintained through Michigan State University. An introductory letter described the goals of the survey and asked the AH to submit contact information for faculty coordinators of teaching, research, and extension within their departments. Forty-nine percent of the administrative heads responded and submitted contact information for 72 faculty members. Survey questions were sent to the identified faculty. The total survey return was 38.9%, 37.7% of the respondents answered questions for teaching, 31.1% for research, and 31.1% for extension. Animal waste, animal welfare, and food safety are examples of issues where all three missions have concentrated efforts. However, graduate student education on issues was identified as lacking emphasis. Animal science departments are responding to contemporary issues in all three of the Land-Grant mission components.

Animal Husbandry↗