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At least 55 records · Page 3Linked to original sources
PubMed2006

Does systems integration affect continuity of mental health care?

Continuity of care is a concern for mental health clients in the post deinstitutionalization era of community care. A proposed solution is systems integration. This paper reviewed research on systems integration, focusing on continuity of care outcomes. A positive association between systems integration and client continuity of care was consistently demonstrated. Better results were obtained in systems characterized by stronger management arrangements, fewer service sectors, and system wide implementation of intensive case management and centralized access to services. Future research should evaluate a wider range of systems integrating mechanisms, using client-based measures that more directly represent continuity of care experiences.

Case Management↗
PubMed2000

Electrochemical approach to the dynamics of molecular recognition of redox enzyme sites by artificial cosubstrates in solution and in integrated systems.

Application of antigen-antibody technology allows the attachment to an electrode surface of an enzyme monolayer structure to which both the enzyme and the mediator are bound. As illustrated with the example of glucose oxidase and a ferrocene mediator, the enzyme preserves its full activity in such structures, which may be easily reproduced. In spite of their fixation to the structure, the mobility of the ferrocene heads is sufficient to ensure that its transport to the enzyme prosthetic group is not rate determining. The reaction is rather controlled by the prior formation of a complex between the ferrocenium ion and the flavin required for electron transfer to occur. The efficiency of this step is affected by steric hindrance and the various observations made with free-moving and attached ferrocene-ended poly(ethylene glycol) chains may be rationalized by the interplay of factors controlling their distribution and shape. Analyzing the dynamics of this system, in comparison with previous systems, was thus an occasion to shed further light on the recognition phenomenon. The enzyme monolayer integrated system is a good starting point for the step-by-step construction of spatially ordered multilayered assemblies with strong catalytic efficiencies. Fast responding systems are expected both in terms of electron transport and electron transfer between the mediator and the enzyme. The spatial order resulting from the step-by-step construction should allow a much more precise analysis of electron transport and electron transfer than in conventional assemblies of redox centers. Mastering both the construction and the functioning of such systems should help the design of more complex systems, integrating additional functionalities electrically controlled by means of their electron transport/electron transfer connection to the electrode surface.

Antigen-Antibody Complex↗
PubMed1995

An integrated system to represent and manage medical knowledge.

This paper describes an integrated system in Prolog that permits the creation of a personal Knowledge Base to express and formalize specialist knowledge in medicine. Formalisms used are production rules and frames. The integrated system is able to manage data and knowledge stored in a database built in M Technology (MUMPS).

AIDS-Related Opportunistic Infections↗
PubMed1990

The benefits and perils of system integration.

The current health care environment is complex, with no single systems solution dominating the marketplace. A new approach utilizes Networked Systems Integration to link disparate systems together. This paper discusses the Systems Integration approach and suggests that it encourages user commitment, provides greater modularity, is cost effective, and supports solutions that offer greater functionality. However, it is noted that this approach is not without problems that can dramatically effect the realization of benefits.

Competitive Bidding↗
PubMed2004

Nitric oxide signaling: systems integration of oxygen balance in defense of cell integrity.

PURPOSE OF REVIEW: Nitric oxide has emerged as a ubiquitous signaling molecule subserving diverse pathophysiologic processes, including cardiovascular homeostasis and its decompensation in atherogenesis. Recent insights into molecular mechanisms regulating nitric oxide generation and the rich diversity of mechanisms by which it propagates signals reveal the role of this simple gas as a principle mediator of systems integration of oxygen balance. RECENT FINDINGS: The molecular lexicon by which nitric oxide propagates signals encompasses the elements of posttranslational modification of proteins by redox-based nitrosylation of transition metal centers and free thiols. Spatial and temporal precision and specificity of signal initiation, amplification, and propagation are orchestrated by dynamic assembly of supramolecular complexes coupling nitric oxide production to upstream and downstream components in specific subcellular compartments. The concept of local paracrine signaling by nitric oxide over subcellular distances for short durations has expanded to include endocrine-like effects over anatomic spatial and temporal scales. From these insights emerges a role for nitric oxide in integrating system responses controlling oxygen supply and demand to defend cell integrity in the face of ischemic challenge. In this context, nitric oxide coordinates the respiratory cycle to acquire and deliver oxygen to target tissues by regulating hemoglobin function and vascular smooth muscle contractility and matches energy supply and demand by down-regulating energy-requiring functions while shifting metabolism to optimize energy production. SUMMARY: Insights into mechanisms regulating nitric oxide production and signaling and their integration into responses mediating homeostasis place into specific relief the role of those processes in pathophysiology. Indeed, endothelial dysfunction associated with altered production of nitric oxide regulating tissue integrity contributes to the pathogenesis underlying atherogenesis. Moreover, this central role in pathophysiology identifies nitric oxide signaling as a key target for novel therapeutic interventions to minimize irreversible tissue damage associated with ischemic cardiovascular disease.

Animals↗
PubMed1999

Automated and integrated system for high-throughput DNA genotyping directly from blood.

An automated and integrated system for DNA typing directly from blood samples has been developed. The multiplexed eight-array system is based on capillary microfluidics and capillary array electrophoresis. Three short-tandem-repeat loci, vWA, THO1, and TPOX, are coamplified simultaneously in a fused-silica capillary by a hot-air thermocycler. Blood is directly used as the sample for polymerase chain reaction (PCR) without any pretreatment. Modifications of standard protocols are necessary for direct PCR from blood. A programmable syringe pump plus a set of multiplexed liquid nitrogen freeze/thaw switching valves are employed for liquid handling in the fluid distribution network. The system fully integrates sample loading, PCR, addition of an absolute standard, on-line injection of sample and standards, separation and detection. The genotypes from blood samples can be clearly identified in eight parallel channels when the electropherograms are compared with that of the standard allelic ladder by itself. Regeneration and cleaning of the entire system prior to subsequent runs are also integrated into the instrument. The instrumentation is compatible with future expansion to hundreds of capillaries to achieve even higher throughput.

Automation↗
PubMed1995

Addressing integrated systems' tax-exemption problems.

Integrating for-profit providers with charitable providers raises many questions about tax exemption. The traditional criteria for determining tax-exempt status that apply to hospitals do not necessarily apply to integrated delivery systems because of their hybrid nature. The appropriate Internal Revenue Service (IRS) rulings and issues must be understood and adhered to before an integration can be structured in the most tax-efficient way. Reasonable as such a course of action seems, it is somewhat difficult because both the integrated delivery system concept and the IRS rulings that apply are evolving. In a time of flux, this article serves as a timely if temporary guide.

Community-Institutional Relations↗
PubMed1985

An integrated system for large scale cell culture.

The potential of tissue culture as a means of production of various viruses for use in vaccines, or various biomolecules such as the interferons, interleukins, various enzymes and growth factors, has been steadily increasing over the last few years. If the full potential for the production of these products is to be realized, significant technological advances in the area of large scale cell culture are required. Most cells producing the above mentioned molecules and products grow only when attached to a surface. Therefore, the ability to harness cell culture as a tool for large scale production of products is dependent on the availability of large surface areas that are biocompatible with cell attachment and growth and are presented in such a form that proper nutrient solutions are continually being offered to the cells. This presentation will describe a closed loop circumfusion system with an available surface area scaleble to 72 m2. This system is integrated with a computer based controller providing programmable monitoring, control, and documentation of the culture. The system has been extensively tested in both in-house and field trials. This testing has shown the system to be compatible with the typical production environment rigors while highlighting the economic potentials of production using this unique system.

Animals↗
PubMed1998

Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness.

OBJECTIVES: This study evaluated the hypothesis that greater integration and coordination between agencies within service systems is associated with greater accessibility of services and improved client housing outcomes. METHODS: As part of the Access to Community Care and Effective Services and Supports program, data were obtained on baseline client characteristics, service use, and 3-month and 12-month outcomes from 1832 clients seen at 18 sites during the first year of program operation. Data on interorganizational relationships were obtained from structured interviews with key informants from relevant organizations in each community (n = 32-82 at each site). RESULTS: Complete follow-up data were obtained from 1340 clients (73%). After control for baseline characteristics, service system integration was associated with superior housing outcomes at 12 months, and this relationship was mediated through greater access to housing agencies. CONCLUSIONS: Service system integration is related to improved access to housing services and better housing outcomes among homeless people with mental illness.

Adult↗
PubMedDate not supplied

Characteristics of hospitals providing preventive services: does delivery system integration make a difference?

OBJECTIVE: As health care organizations consolidate into integrated delivery systems, increased delivery of preventive services is expected. The study objective was to evaluate the impact of hospitals' participation in multiorganizational arrangements and managed care on their delivery of preventive services. METHOD: The study is a secondary data analysis of data in the American Hospital Association 1993 Annual Survey of Hospitals Data Base. Two primary prevention variables (health promotion services to patients and to community members), and one secondary prevention variable (screening mammography) were included. Hospital characteristics included ownership, bed-size, and integration-participation in a multiorganizational arrangement and having managed care (HMO and PPO) contracts. RESULT: The 5,387 general medical and surgical hospitals responding to the 1993 survey were included in the analysis. Proportions of hospitals reporting delivery of health promotion services to patients, and to community members, and screening mammography services were respectively 90%, 83%, and 88%. Hospitals reporting participation in multiorganizational arrangements were more likely to report delivery of preventive services after adjusting for bed-size. The bed-adjusted odds ratios for providing health promotion services to inpatients, and to members of the community, and screening mammography services in hospitals with managed care contracts versus those without managed care contracts were respectively: 2.72 (95% CI: 1.65, 2.50), 2.03 (1.63, 2.53), and 1.51 (1.26, 1.81). CONCLUSION: Preliminary findings from this secondary data analysis support the expectation that current changes in the health care delivery system may expand the delivery of preventive services.

Accreditation↗
PubMed1987

An integrated system for interstitial 192Ir implants.

An efficient system for preparing, afterloading, and removing interstitial 192Ir strands has been developed. Use of the system reduces the risk of personnel exposure and eliminates some patient discomfort. The system is "integrated" in that all aspects of the implantation process are considered, from source preparation to source removal. Strand preparation is facilitated by an "assembly line" process using shielded equipment. Components include a handling block for measuring and cutting active strands, a mirror, and a transport container. Afterloading and removal techniques use quick release devices and several forms of afterloading tubing and catheters, each terminated by a Luer lock adapter. Both blind-end and through-and-through implants are possible. Each 192Ir strand, threaded through an injection cap that mates with the Luer lock adapter, is quickly inserted into its tubing or catheter and locked into place. No crimping is required and no additional positioning of the sources is needed. Strand removal is easily accomplished by unlocking and removing the injection cap. The strands receive no mechanical damage and can be reused after appropriate cleaning. More than 100 cases have been performed without incident. Applications include head/neck, breast, and template and non-template vaginal wall treatments.

Brachytherapy↗
PubMed1992

Estimates of stability time for nearly integrable systems with a quasiconvex Hamiltonian.

A Hamiltonian system differing from an integrable system by a small perturbation equals, similar varepsilon is analyzed. According to the Nekhoroshev theorem, the changes in the perturbed motion of the "action" variables of the unperturbed system are small over a time interval which increases exponentially in length as varepsilon decreases linearly. If the unperturbed Hamiltonian is a quasiconvex function of these "actions," the changes in them remain small ( equals, similar varepsilon (1/2n)) over a time interval on the order of exp(const/ varepsilon (1/2n)), where n is the number of degrees of freedom of the system.

Journal Article↗
PubMed2003

From data to knowledge in e-health applications: an integrated system for medical information modelling and retrieval.

The system described in this paper uses the technological advances in information technology in order to influence and improve healthcare practice by enabling the flexible modelling, direct representation and adaptable use of medical knowledge. It aims at resolving a number of difficulties encountered by current information repositories, such as costly customization, reusability, high maintenance and poor information modelling, by employing the architecture of the functional data model (FDM), while maintaining full interoperability with existing systems by means of XML. On the information-modelling front the system supports a variety of modelling techniques that are especially relevant to medical applications, such as complex objects, incomplete or missing information, partially structured data and multimedia content. A prototype implementation of the system has been developed which consists of a multimedia-enhanced version of the functional database language FDL, and a web-based, two-way translator interface between the application's native language and XML. This interface provides full interoperability with other, heterogeneous systems over the web, thus, significantly reducing the complexity of developing distributed healthcare systems and e-health applications.

Computer Communication Networks↗
PubMed2006

TMABoost: an integrated system for comprehensive management of tissue microarray data.

In the last decade, high-throughput technologies such as DNA and tissue microarrays (TMAs) have become a means of large-scale investigation of gene expression, providing a plethora of new biomedical data in a relatively short time. Data collection and organization are critical aspects in this process to ensure the quality and reliability of future data interpretation. In this work, we propose a comprehensive approach to handle TMA data with the aim of supporting and promoting biomarker development. We describe a web-based system for the complete management of tissue microarray data in the field of pathology. The system has been in use since June, 2003. Our approach includes automatic localization and identification of tissue microarray samples, and quantitative image analysis that allows high-throughput screening of TMAs by ensuring nonsubjective measures and novel prognosis associations. In this paper, we present the architecture and the components of this system.

Algorithms↗