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At least 685 records · Page 38Linked to original sources
PubMed2005

Using concept mapping to design an indicator framework for addiction treatment centres.

OBJECTIVE: The objective of this study is to determine an indicator framework for addiction treatment centres based on the demands of stakeholders and in alignment with the European Foundation for Quality Management (EFQM) Excellence Model. SETTING: The setting is the Jellinek Centre based in Amsterdam, the Netherlands, which serves as a prototype for an addiction treatment centre. METHOD: Concept mapping was used in the construction of the indicator framework. During the 1-day workshop, 16 stakeholders generated, prioritized and sorted 73 items concerning quality and performance. Multidimensional scaling and cluster analysis was applied in constructing a framework consisting of two dimensions and eight clusters. RESULTS: The horizontal axis of the indicator framework is named 'Organization' and has two poles, namely, 'Processes' and 'Results'. The vertical axis is named ' Task' and the poles are named 'Efficient treatment' and 'Prevention programs'. The eight clusters in the two-dimensional framework are arranged in the following, prioritized sequence: 'Efficient treatment network', 'Effective service', ' Target group', 'Quality of life', 'Efficient service', 'Knowledge transfer', 'Reducing addiction related problems', and 'Prevention programs'. The most important items in the framework are: 'patients are satisfied with their treatment', 'early interventions', and 'efficient treatment chain'. CONCLUSION: The indicator framework aligns with three clusters of the results criteria of the EFQM Excellence Model. It is based on the stakeholders' perspectives and is believed to be specific for addiction treatment centres. The study demonstrates that concept mapping is a suitable strategy for generating indicator frameworks.

Benchmarking↗
PubMed2003

Calcium current subtypes in GnRH neurons.

Calcium plays roles in excitability, rhythm generation, and neurosecretion. Identifying channel subtypes that regulate calcium influx is thus important to understanding rhythmic GnRH secretion, which is a prerequisite for reproduction. Whole-cell voltage-clamp recordings were made from short-term dissociated GnRH adult ovariectomized (OVX) mice (n = 21) to identify channel subtypes that carry calcium current using selective channel blockers and voltage characteristics. Low-voltage activated (LVA) currents were not observed in 42 GnRH neurons tested, although most non-GnRH neurons (4/6) displayed LVA current. The L-type component of the high-voltage activated (HVA) calcium current was 25% +/- 2%. The remaining HVA calcium current passed through N-type (27% +/- 3%), P-type (15% +/- 1%), Q-type (18% +/- 3%), and R-type (15% +/- 1%) channels. Because these data differ substantially from reports on cultured GnRH neurons, which may represent reproductively immature models, we also examined GnRH neurons from gonadal-intact young (Postnatal Days 4-10, n = 8 mice) mice. LVA currents were still rare (2/28) in young mice. Although the same HVA components were observed, the proportions were shifted toward significantly more L-type and less N-type current, suggesting a possible developmental shift in calcium currents in GnRH neurons. These data suggest that calcium channel subtypes in GnRH neurons prepared in the short term from brain slices differ substantially from those in long-term cultured GnRH models. These findings provide a vital foundation to examine the role of calcium channels in the secretory and rhythmic machinery of GnRH neurons.

Agatoxins↗
PubMed1993

If they don't ask these questions, give them the answers.

Clinicians must be active rather than passive participants in the design process. This article lists basic concepts that pertain to the model of care and are the foundation of the design. Clinicians must be in agreement on these concepts and discuss the rationale for them with the design team to establish the project goals.

Decision Making, Organizational↗
PubMed1993

Toward a hierarchy of adaptation to biomedical technology.

The article attempts to derive a hierarchy of patient adaptation for a variety of technologic devices that are used in medical and nursing care. A review of related literature on some existing taxonomies of biomedical technology and an empiric foundation based on Roy's Adaptation Model suggest that patient adaptation to biomedical devices is affected by at least two factors--the degree of invasiveness and automation--that are inherent in all bedside devices. It appears that patients' need for adaptation to technology is more apparent as automation decreases and invasiveness increases. Further research is necessary to determine whether this relationship holds for all types of technology and to identify additional factors that might contribute to the development of an adaptation hierarchy for technologic devices. The nurse's role as a mediator of stress between the patient and technology is also explored.

Adaptation, Psychological↗
PubMed2026

Molecular biomarker profiling in noninfectious uveitis: a chronological review of discovery.

PURPOSE OR REVIEW: Noninfectious uveitis (NIU) encompasses a heterogeneous group of immune-mediated intraocular inflammatory diseases whose complexity has driven systematic molecular biomarker discovery. This review presents NIU molecular biomarkers organized by biological category; autoantigens, human leukocyte antigens (HLA) and genetic markers, cellular immune subsets, cytokines, chemokines, and multiomics platforms including proteomics, microbiome metagenomics, metabolomics, and single-cell transcriptomics with each category presented in strict chronological order of landmark discovery. RECENT FINDINGS: We present a review organized along two nested timelines. Categories are presented in the order they historically emerged in the field, and within each category, landmark discoveries appear in chronological sequence. This allows the reader to trace how each biomarker category evolved: from foundational autoantigen identification in experimental uveitis models, through the genomic revolution of HLA association studies, into cellular immunophenotyping, cytokine profiling of aqueous humor, chemokine mapping of intraocular trafficking, and finally the emerging omics platforms that may potentially anchor precision medicine in NIU. Each biomarker is paired in line with its linked targeted therapeutic. SUMMARY: Biomarker research has transformed the understanding of NIU from a clinically defined syndrome into a group of molecularly distinct immune disorders. Advances spanning autoantigens, genetics, immune-cell profiling, cytokines, chemokines, and multiomics have revealed novel pathogenic mechanisms and therapeutic targets. Integration of these biomarkers with targeted therapies may accelerate the transition toward precision medicine in uveitis care.

cytokines↗
PubMed2001

TQM in dental practice.

Society now expects more from its doctors and dentists, and these increasing demands can be summed up in one relatively new term for the medical profession: "quality management" (QM). Doctors and dentists formerly took the view that their performance could be assessed solely on the basis of their technical skills, ethics and expertise, but are now confronted with a new social imperative, from outside the profession--quality management. The author, prize-winner of the European Quality Award 2000 describes his approach to introduce the European Foundation for Quality Management (EFQM) Excellence Model in his dental practice. He shows that the EFQM model is well suited as a basis for a quality management system in healthcare.

Benchmarking↗
PubMedDate not supplied

Motivation: the most basic process in TQM/CQI.

Quality management professionals confront the challenge of motivating others to participate in the improvement of patient care. Producing this motivation frequently proves problematic. This article addresses the issue of motivation by presenting it as a process. Abraham Maslow's hierarchy of needs functions as the foundation of the process. A process model is used to demonstrate that satisfaction of the higher-level needs of esteem and self-actualization is required to produce true motivation. By understanding the process of motivation, we may become more effective in improving patient care.

Humans↗
PubMed2026

Large-scale multiethnic electronic health record resource for diabetes complications research: the North West London Diabetes Cohort (NWLDC) - cohort profile.

PURPOSE: The North West London Diabetes Cohort is established to provide systematic characterisation of a large diabetes population as a foundation for complications research and prognostic modelling. Many predictive modelling studies neglect the essential descriptive characterisation of underlying cohorts, focusing narrowly on model accuracy. This cohort profile addresses this gap by comprehensively describing the demographic composition, clinical characteristics and complication incidence patterns. The notably diverse, multiethnic population enables examination of ethnic disparities and supports future development of reliable prognostic models and evidence-based prevention strategies for diabetes complications. PARTICIPANTS: At baseline, 337 271 patients with diabetes were identified. It includes 279 067 patients with type 2 diabetes, 17 638 with type 1 diabetes, 33 590 with gestational diabetes and 6916 with unspecified diabetes. The earliest diabetes diagnosis dates to January 1932, with data updated to 27 May 2025. FINDINGS TO DATE: This cohort profile describes baseline characteristics of patients with comprehensive data collected on demographics (age, sex, Deprivation Index, ethnicity), clinical measures (glycated haemoglobin, body mass index, blood pressure, lipids and estimated glomerular filtration rate) and 14 major diabetes complications tracked longitudinally. Key findings for patients with type 2 diabetes reveal diabetic retinopathy as the most common complication (74.6 per 1000 person-years), followed by hypertension (51.0) and kidney disease (31.4). Cumulative incidence analyses using the Aalen-Johansen estimator, which accounts for mortality as a competing risk, demonstrated significant ethnic disparities, with black, Asian, mixed and other ethnic groups showing elevated risk compared with white patients. Time-varying Cox models identified strong clustering between cardiovascular and renal complications, confirming a cardiometabolic-renal syndrome. Mental health conditions (depression and anxiety) were prevalent throughout the disease timeline, occurring both before and after diabetes diagnosis. FUTURE PLANS: This cohort will be used as a platform for developing and validating prognostic models for diabetes complications, enabling risk stratification and targeted interventions. Future work will incorporate medication data to refine diabetes type classification, examine the effectiveness of antidiabetic medications in preventing different complications and address demographic differences in prognostic model performance and prediction accuracy. To better characterise lifestyle, further interrogation of electronic health record data will examine recording of advice given, including dietary advice, referral to weight management schemes and presence of alcohol consumption codes.

Humans↗
PubMed2001

Energizing epithelial transport with the vacuolar H(+)-ATPase.

The Ussing model has long provided the conceptual foundation for understanding epithelial transport mechanisms energized by the Na(+)-K(+)-ATPase. Plasma membranes may also use the vacuolar (V-type) H(+)-ATPase as the primary energy source of membrane and epithelial transport. A pure electrogenic pump, the V-type H(+)-ATPase energizes not only membranes it inhabits but also other transport pathways via electrical coupling.

Animals↗
PubMed2001

Wounding, doubting, and trusting in suffering.

Constructs a working model of pastoral care on the foundation of the reality of suffering. Explicates how suffering wounds the person both psychologically and spiritually and how doubting God can be a constructive phase leading to the reclaiming of trust in God.

Adaptation, Psychological↗
PubMed2026

Deep learning-based multimodal pathogenomics integration for precision cancer prognosis.

BACKGROUND: Recent studies have revealed valuable prognostic insights in haematoxylin and eosin (H&E)-stained histological sections and transcriptomic profiles, suggesting potential applications in machine learning. However, existing methods lack sufficient intra- and inter-modal interactions, and face challenges in clinical validation due to incomplete multimodal data. METHODS: We proposed PathoGems (PathoGenomics-based integrative survival prediction), a weakly-supervised, interpretable multimodal learning framework that integrates histology and genomic profiles for precise cancer prognosis prediction. To evaluate the robustness of PathoGems, we initially curated a dataset of 1965 cases across four cohorts from The Cancer Genome Atlas (TCGA), including breast, colorectal, glioblastoma, and esophageal cancers. For external validation, PathoGems was further evaluated on four independent cohorts, consisting of 76 breast cancer and 41 esophageal squamous cell carcinoma cases from Zhejiang Cancer Hospital, as well as 102 colorectal cancer and 58 glioblastoma cases from the Clinical Proteomic Tumor Analysis Consortium (CPTAC). RESULTS: PathoGems effectively stratified patients into favorable and unfavorable risk groups, revealing significant differences in histological patterns, genomic features, and overall survival (log-rank test, p&#x2009;<&#x2009;0.05). Moreover, the model&#x2019;s predictions are further supported by visualization and transcriptomic analysis, enhancing interpretability and reliability. CONCLUSIONS: By fusing histological and clinicogenomic multimodal models, PathoGems will provide a solid foundation for developing an innovative tool that aids clinicians in making informed decisions and selection personalized treatment strategies for cancer patients.

Humans↗
PubMed1997

Outpatient rehabilitation program for clients with persisting mild to moderate symptoms following traumatic brain injury.

Assessment and treatment of the symptoms produced by mild to moderate brain injury are most effective when an interdisciplinary, distributed practice approach is used in an outpatient environment. In this article I present a model program that uses a neuropsychological foundation for community-based rehabilitation. Program description and an efficacy study are discussed.

Journal Article↗
PubMed1998

Cultural competence for nurses: canonical correlation of two culture scales.

As the diversity of the US residential population increases, healthcare professionals need to recognize the importance of culturally competent care on health outcomes of individuals and communities. The purpose of this descriptive correlational pilot study (N = 51) was to describe the relationship among scores and sub-scores on scales measuring concepts of cultural competence. An additional purpose was to develop reliability and validity data on each of three culture scales for the population of hospital based registered nurses. Each of the scales had previously reported reliability and validity data but were administered to populations potentially different from southern-based, hospital-employed RNs. A large medical center located in Southeastern US was chosen as the study's site due to its diverse staff and client base. The Giger and Davidhizar Transcultural Assessment Model and Theory was the theoretical foundation for the study and Cultural Self-Efficacy Scale (CSES), Cultural Attitude Scale as developed by Bonaparte (1977, 1979) and modified by Rooda (1990, 1992) (CAS-Modified), and knowledge base questions (Rooda, 1990) were the chosen instruments. For this group of hospital based RNs, the reliability analysis--scale (Alpha) for the 58 item CSES was .9778. The reliability analysis (Alpha) for the 22 knowledge base questions was .6038 and .6412 for the 40 item CAS-M. Canonical correlation analysis was performed between a set of attitude variables and a set of self efficacy variables using SPSS (1995). Both sets of variables demonstrated statistically significant relationships (at an a priori alpha of .05) to each other (with an approximate Eta squared value for practical significance of .336), providing sufficient evidence to reject the non-relationship null hypothesis. For this sample and for these data, cultural self-efficacy toward Asian, Black, Hispanic clients, and self-efficacy regarding nursing skills when caring for diverse clients related to cultural attitudes and cultural self-efficacy. Nursing care, cultural health beliefs, and cultural health attitudes related to attitudes toward care of diverse clients. Both sets of variables related to each other as qualities of culturally competent nursing care.

Adult↗
PubMed1985

Coalition provides hospital-based services for pregnant teens.

After identifying the need to provide programs offering alternatives to abortion in the Buffalo, NY, diocese, the bishop, health care administrators, and social workers began in-service training sessions to inform the community about the need for services and for advertising existing services. The group found that the northern part of the diocese had no accessible services. In 1981, after weeks of meetings, respect life coordinators, hospital administrators, and social service agencies formed Women's Health Services (WHS), an emergency pregnancy hotline based at Kenmore (NY) Mercy Hospital. WHS is cosponsored by four local agencies, three diocesan and one private, who share administrative, managerial, and educational responsibilities. WHS offers free pregnancy testing, hotline counseling, prenatal clinic and residential care, and crisis intervention. The coalition agencies share equally in instructing the volunteer staff, who form the program's foundation. WHS serves as a role model for other dioceses, communities, and health facilities that seek ways to provide a needed health care service.

Adolescent↗
PubMed2001

Integration of nursing assessment concepts into the medical entities dictionary using the LOINC semantic structure as a terminology model.

Recent investigations have tested the applicability of various terminology models for the representing nursing concepts including those related to nursing diagnoses, nursing interventions, and standardized nursing assessments as a prerequisite for building a reference terminology that supports the nursing domain. We used the semantic structure of Clinical LOINC (Logical Observations, Identifiers, Names, and Codes) as a reference terminology model to support the integration of standardized assessment terms from two nursing terminologies into the Medical Entities Dictionary (MED), the concept-oriented, metadata dictionary at New York Presbyterian Hospital. Although the LOINC semantic structure was used previously to represent laboratory terms in the MED, selected hierarchies and semantic slots required revisions in order to incorporate the nursing assessment concepts. This project was an initial step in integrating nursing assessment concepts into the MED in a manner consistent with evolving standards for reference terminology models. Moreover, the revisions provide the foundation for adding other types of standardized assessments to the MED.

Dictionaries, Medical as Topic↗
PubMed2002

Electronic signature for medical documents--integration and evaluation of a public key infrastructure in hospitals.

OBJECTIVES: Our objectives were to determine the user-oriented and legal requirements for a Public Key Infrastructure (PKI) for electronic signatures for medical documents, and to translate these requirements into a general model for a signature system. A prototype of this model was then implemented and evaluated in clinical routine use. METHODS: Analyses of documents, processes, interviews, observations, and of the available literature supplied the foundations for the development of the signature system model. Eight participants of the Department of Dermatology of the Heidelberg University Medical Center evaluated the implemented prototype from December 2000 to January 2001, during the course of an intervention study. By means of questionnaires, interviews, observations and database analyses, the usefulness and user acceptance of the electronic signature and its integration into electronic discharge letters were established. RESULTS: Since the major part of medical documents generated in a hospital are signature-relevant, they will require electronic signatures in the future. A PKI must meet the multitude of responsibilities and security needs required in a hospital. Also, the signature functionality must be integrated directly into the workflow surrounding document creation. A developed signature model, fulfilling user-oriented and legal requirements, was implemented using hard and software components that conform to the German Signature Law. It was integrated into the existing hospital information system of the Heidelberg University Medical Center. At the end of the intervention study, the average acceptance scores achieved were mean = 3.90; SD = 0.42 on a scale of 1 (very negative attitude) to 5 (very positive attitude) for the electronic signature procedure. Acceptance of the integration into computer-supported discharge letter writing reached mean = 3.91; SD = 0.47. On average, the discharge letters were completed 7.18 days earlier. CONCLUSION: The electronic signature is indispensable for the further development of electronic patient records. Application-independent hard and software components, in accordance with the signature law, must be integrated into electronic patient records, and provided to certification services using standardized interfaces. Signature-oriented workflow and document management components are essential for user acceptance in routine clinical use.

Authorship↗