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At least 631 records · Page 35Linked to original sources
PubMed1999

DNA sequencing by capillary electrophoresis (review).

DNA sequencing by capillary electrophoresis has been reviewed with an emphasis on progress during the last four years. The effects of sample purification, composition of sieving matrices, electric field strength, temperature, wall coating and DNA labeling on the DNA sequencing performance are discussed. Multicapillary array instrumentation is compared with one-capillary systems. Integrated systems that perform the whole DNA sequencing operation online starting from the DNA amplification through base calling and data processing are discussed.

Bacteriophage M13↗
PubMed2006

Sample to sample carryover: a source of analytical laboratory error and its relevance to integrated clinical chemistry/immunoassay systems.

BACKGROUND: Integrated systems that combine clinical chemistry and immunoassay analyzers are used routinely. Sample to sample carryover is an inherent risk and can cause erroneously high patient test results for immunoassays. IVD manufacturers and laboratories must be aware of this phenomenon and guard against it. METHODS: We used a sample carryover protocol that directs the clinical chemistry module to process samples with very high immunoassay analyte concentrations followed by samples with very low concentrations for the same analyte. Low concentration samples were then tested by the immunoassay module to determine if the clinical chemistry module caused primary sample tube to primary sample tube carryover of the immunoassay analyte. RESULTS: Sample carryover was assessed on the Abbott ci8200 for HBsAg, AFP, beta-hCG, and PSA. Observed HBsAg carryover met the design specification of <0.1 ppm. Carryover for the other analytes was <0.1 ppm or below the assay limit of detection. CONCLUSIONS: IVD manufacturers must design integrated systems to minimize primary specimen tube carryover and avoid analytical laboratory error that can impact patient safety. Carryover testing is difficult for clinical laboratories to perform in order to verify system performance. Laboratories must consider the potential for specimen carryover and its impact on results whether moving primary sample tubes between separate analyzers or using an integrated system.

Clinical Chemistry Tests↗
PubMed2006

Towards a portable microchip system with integrated thermal control and polymer waveguides for real-time PCR.

A novel real-time PCR microchip platform with integrated thermal system and polymer waveguides has been developed. The integrated polymer optical system for real-time monitoring of PCR was fabricated in the same SU-8 layer as the PCR chamber, without additional masking steps. Two suitable DNA binding dyes, SYTOX Orange and TO-PRO-3, were selected and tested for the real-time PCR processes. As a model, cadF gene of Campylobacter jejuni has been amplified on the microchip. Using the integrated optical system of the real-time PCR microchip, the measured cycle threshold values of the real-time PCR performed with a dilution series of C. jejuni DNA template (2 to 200 pg/microL) could be quantitatively detected and compared with a conventional post-PCR analysis (DNA gel electrophoresis). The presented approach provided reliable real-time quantitative information of the PCR amplification of the targeted gene. With the integrated optical system, the reaction dynamics at any location inside the micro reaction chamber can easily be monitored.

Bacterial Outer Membrane Proteins↗
PubMedDate not supplied

Pharmaceutical care in an integrated health system.

OBJECTIVES: An integrated health system in a large metropolitan area, to maximize its manpower and resources, developed a pharmacist-operated Health Management Center (HMC). The primary objectives of the HMC are to provide a continuum of patient care, decrease emergency department visits, decrease episodes of hospitalization, and increase patient satisfaction and quality of life. SETTING: The HMC based at a 300-bed community hospital of an integrated health system in a large metropolitan area. PRACTICE DESCRIPTION/INNOVATION: Chronic diseases, including coagulation disorders, asthma, diabetes, hypertension, congestive heart failure, and dyslipidemia, will be managed by the primary care pharmacist at the HMC. The HMC pharmacist uses a team approach to promote good health by cooperating with patients, the physician clinic director, and other professionals in designing, implementing, and monitoring therapeutic plans that produce specific therapeutic outcomes. The pharmacist evaluates patients using physical assessment skills; performs point-of-care laboratory tests; obtains medication history, including information on compliance, response to drug therapy, and adverse reactions; adjusts and orders medications; and schedules follow-up appointments. INTERVENTIONS: The anticoagulation service was the first program to be established. The pharmacist is authorized to perform point-of-care testing for prothrombin times, adjust doses of anticoagulants, order vitamin K, and schedule return visits per established guidelines. MAIN OUTCOME MEASURES: Emergency department visits, episodes of hospitalization, patient satisfaction, and quality of life. RESULTS: The results for 39 patients 6 months before their enrollment in the HMC's anticoagulation service and for the first 6 months following their enrollment, after adjusting for a 1-month-washout period, showed a decrease in hospitalization rate by 57.9% (p = .078) and total hospital days by 71.1% (p = .108). No change was observed in use of emergency department services. CONCLUSION: The role of the pharmacist at the HMC is a reflection of changes in the health care system that are leading to greater pharmacist involvement in direct patient care. The pharmacist-operated HMC can serve as a model for other hospitals in this and other integrated health systems.

Delivery of Health Care, Integrated↗
PubMed1993

Quality assurance: a system that integrates a digital dictation system with a computer data base.

One of the most challenging responsibilities for radiologists is assessment of the quality of care that they provide. Some parameters of quality, such as false-negative rate, are almost impossible to calculate with absolute precision. The issue is also complicated when one tries to determine exactly what constitutes a "discordant" interpretation. However, even when a radiologist discovers that a radiographic finding was missed, or that an inappropriate examination was done, the steps necessary to perform an analysis of the problem can be very disruptive to one's clinical focus at the moment. This suggests that a major obstacle to participation in quality assurance by radiologists is the lack of an adequate infrastructure. We have integrated our digital dictation system with a personal computer data base for tracking cases appropriate for quality assurance, thus allowing radiologists to log any examination from any dictation station in our department with minimal interruption to their clinical activities. Quality assurance and peer review are facilitated by using a personal computer for otherwise tedious aspects of information management. Radiology departments that have a convenient, department-wide method for entering cases--such as a digital dictation system--are ideal for this technique.

Humans↗
PubMed1997

Promoting physician productivity through a variable compensation system.

Integrated delivery systems must find ways to achieve optimal physician productivity and accountability, while fostering an entrepreneurial attitude among physicians. Lovelace Health Systems, Albuquerque, New Mexico, has implemented a variable compensation system designed for this purpose. An assessment of Lovelace's physician productivity had indicated performance well below national medians. To offer physicians a strong incentive to increase productivity, Lovelace developed a variable compensation system based on the resource-based relative value scale and relative value units. Lovelace also developed benchmark productivity targets.

Delivery of Health Care, Integrated↗
PubMed1994

Technology management: case study of an integrated health system.

Technology management has assumed a role of vital importance in today's health care environment. Capital reserves and operating income have been stretched by pervasive and expensive technologies, while overall reimbursement has been reduced. It is imperative for hospitals to develop and consistently use technology management processes that begin prior to a technology's introduction in the hospital and continue throughout its life cycle. At Samaritan Health System (SHS), an integrated health care delivery system based in Phoenix, technology management provides tools to improve decision making and assist in the system's integration strategy as well as control expenses. SHS uses a systemwide technology-specific plan to guide acquisition and/or funding decisions. This plan describes how particular technologies can help achieve SHS' organizational goals such as promoting system integration and/or improving patient outcomes while providing good economic value. After technologies are targeted in this systemwide plan they are prioritized using a two-stage capital prioritization process. The first stage of the capital prioritization process considers the quantitative and qualitative factors critical for equitable capital distribution across the system. The second stage develops a sense of ownership among the parties that affect and are affected by the allocation at a facility level. This process promotes an efficient, effective, equitable, and defensible approach to resource allocation and technology decision making. Minimizing equipment maintenance expenditures is also an integral part of technology management at SHS. The keys to reducing maintenance expenditures are having a process in place that supports a routine fiscal evaluation of maintenance coverage options and ensuring that manufacturers are obligated to provide critical maintenance resources at the time of equipment purchase. Maintenance service options under consideration in this report include full-service contracts with the manufacturer, insurance coverage, time and materials, and independent service vendors/in-house support. Careful consideration of all the ramifications of each option is warranted because there are substantial cost differences among these methods. At SHS, technology management efforts resulted in equipment purchases and maintenance negotiations representing savings of more than $1.5 million in a single year. SHS undertakes an intensive review of purchases and maintenance expenditures, using the techniques described in this report, with the objective of reducing expenses by 10% per year. This report describes the technology management methods that SHS uses to achieve these results.

Arizona↗
PubMed1983

The Georgetown University Library Information System (LIS): a minicomputer-based integrated library system.

Georgetown University's Library Information System (LIS), an integrated library system designed and implemented at the Dahlgren Memorial Library, is broadly described from an administrative point of view. LIS' functional components consist of eight "user-friendly" modules: catalog, circulation, serials, bibliographic management (including Mini-MEDLINE), acquisitions, accounting, networking, and computer-assisted instruction. This article touches on emerging library services, user education, and computer information services, which are also changing the role of staff librarians. The computer's networking capability brings the library directly to users through personal or institutional computers at remote sites. The proposed Integrated Medical Center Information System at Georgetown University will include interface with LIS through a network mechanism. LIS is being replicated at other libraries, and a microcomputer version is being tested for use in a hospital setting.

Computers↗
PubMed2003

TLC-Asthma: an integrated information system for patient-centered monitoring, case management, and point-of-care decision support.

A great deal of successful work has been done in the area of EMR development, implementation, and evaluation. Less work has been done in the area of automated systems for patients. Efforts to link data at multiple levels - the patient, the case manager, and the clinician have been rudimentary to-date. In this paper we present a model information system that integrates patient health information across multiple domains to support the monitoring and care of children with persistent asthma. The system has been developed for use in a multi-specialty group practice and includes three primary components: 1) a patient-centered telephone-linked communication system; 2) a web-based alert reporting and nurse case-management system; and 3) EMR-based provider communication to support clinical decision making at the point-of-care. The system offers a model for a new level of connectivity for health information that supports customized monitoring, IT-enabled nurse case-managers, and the delivery of longitudinal data to clinicians to support the care of children with persistent asthma. Systems like the one described are well-suited, perhaps essential, technologies for the care of children and adults with chronic conditions such as asthma.

Adolescent↗
PubMed2001

Improved prognostication of renal cell carcinoma using an integrated staging system.

PURPOSE: To integrate stage, grade, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) into a clinically useful tool capable of stratifying the survival of renal cell carcinoma (RCC) patients. PATIENTS AND METHODS: The medical records of 661 patients undergoing nephrectomy at University of California Los Angeles between 1989 and 1999 were evaluated. Median age was 61 years, male-to-female ratio was 2.2:1, and median follow-up was 37 months. Survival time was the primary end point assessed. Sixty-four possible combinations of stage, grade, and ECOG PS were analyzed and collapsed into distinct groups. The internal validity of the categorized was challenged by a univariate analysis and a multivariate analysis testing for the accountability of each UCLA Integrated Staging System (UISS) category against independent variables shown to have impact on survival. RESULTS: Combining and stratifying 1997 tumor-node-metastasis stage, Fuhrman's grade and ECOG PS resulted in five survival stratification groups designated UISS, and numbered I to V. The projected 2- and 5-year survival for the UISS groups are as follows for the groups: I, 96% and 94%; II, 89% and 67%; III, 66% and 39%; IV, 42% and 23%; and V, 9% and 0%, respectively. UISS accounted for the significant variables in the variate analysis. CONCLUSION: A novel system for staging and predicting survival for RCC integrating clinical variables is offered. UISS is simple to use and is superior to stage alone in differentiating patients' survival. Our data suggests that UISS is an important prognostic tool for counseling patients with various stages of kidney cancer. Further prospective large-scale validation with external data is awaited.

Adult↗
PubMed1998

Charting the information technology direction for an integrated delivery system.

Automating the healthcare integrated delivery system requires a special set of skills, talent, and communication that goes beyond the capability of the i.t. manager alone. Bringing together all elements of the integrated delivery system and forming a well-integrated information environment will require a level of teamwork rarely seen in any industry. Today's IT manager is like an orchestra conductor. He or she should look ahead in the musical composition, manage the tempo, and bring all the sounds of the eclectic set of instruments together in harmony and achievement of the melody. Following the key success factor outlined here may not guarantee success in automating the integrated delivery system, but following them should keep the process harmonious.

Computer Communication Networks↗
PubMed1997

Using case management systems to integrate clinical and financial data.

Integrated delivery systems can use automated case management information systems to better manage relevant clinical and financial data across the continuum of care. Effective case management systems can help caregivers track clinical and financial information; match appropriate resources to patient needs; and analyze populations to identify risk, enhance adherence to clinical guidelines, and understand provider treatment profiles.

Case Management↗
PubMed1994

Implementing organized delivery systems: an integration scorecard.

Organized vertically integrated health systems are in a key position to play a major role in present health care reform efforts. To demonstrate a competitive advantage in the new health care environment, however, integration efforts must be successful. Based on a national study of nine organized delivery systems, this article develops measures of three types of integration that occur in vertically integrated health systems--functional, physician-system, and clinical. These measures can be used as a "scorecard" to assess progress toward achieving integration objectives.

Comprehensive Health Care↗
PubMed1992

Wheelchair-mounted integrated control systems for multiply handicapped people.

Integrated control systems allow disabled people access to multiple functions from a single input device (for example a set of switches). Multiply handicapped users are thereby able to switch efficiently between wheelchair control, communication, computer access and control of their environment, without third-party help. Integrated systems have been developed for multiply handicapped children and adults in the Barnsley area. The design philosophy has concentrated upon utilizing, wherever possible, commercially available assistance devices and remotely controlling these via logic-based integrated control systems tailored to the needs and abilities of the individual client. This approach presents few problems as the inputs to commercially available devices are often based on simple switch control. The systems already supplied have proved, after an initial training period, to be easy to operate and have led to a considerable improvement in quality of life for the users. Computer-based, wheelchair-mounted integrated systems are now being developed. A prototype system currently emulates the logic-based controllers described above, employing the screen to display information on the current status of the system. Future development will move toward a more flexible system which will be able to read a variety of input signals and control a large number of outputs. The system will also have the facility to utilize software-based communications, keyboard emulation and environmental control packages as well as business and education software. Such a system could be easily set up, via software, for use by any disabled person.

Biomedical Engineering↗
PubMed1990

Human immunodeficiency virus integration in a cell-free system.

Integration of the viral genome into the nuclear DNA of a host cell plays a pivotal role in the replication of retroviruses. We have developed an in vitro method for studying the biochemistry of human immunodeficiency virus (HIV) integration by using extracts from HIV-infected cells. Analysis of the reaction products showed that HIV integration in vitro accurately reproduces the in vivo process. Integration occurred without apparent specificity for the target sequence, and the integrated provirus was directly flanked by a 5-base-pair duplication of DNA from the target site. HIV integration did not require a high-energy cofactor, and the enzymatic activities required for integration were recovered with the viral DNA when cell extracts were fractionated by gel exclusion chromatography.

Base Sequence↗
PubMed1994

Organizational and business issues affecting integrated delivery systems.

This chapter discusses the nature of an integrated system, the reasons for developing an integrated delivery system, and various organizational structures that might be used. The chapter then identifies several of the critical business issues affecting the development of an integrated system.

Financial Management↗