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PubMed2004

Using online analytical processing to manage emergency department operations.

The emergency department (ED) is a unique setting in which to explore and evaluate the utility of information technology to improve health care operations. A potentially useful software tool in managing this complex environment is online analytical processing (OLAP). An OLAP system has the ability to provide managers, providers, and researchers with the necessary information to make decisions quickly and effectively by allowing them to examine patterns and trends in operations and patient flow. OLAP software quickly summarizes and processes data acquired from a variety of data sources, including computerized ED tracking systems. It allows the user to form a comprehensive picture of the ED from both system-wide and patient-specific perspectives and to interactively view the data using an approach that meets his or her needs. This article describes OLAP software tools and provides examples of potential OLAP applications for care improvement projects, primarily from the perspective of the ED. While OLAP is clearly a helpful tool in the ED, it is far more useful when integrated into the larger continuum of health information systems across a hospital or health care delivery system.

Decision Support Systems, Clinical↗

PubMed2006

The struggle for social integration in the community--the experiences of people with mental health problems.

The goal of social integration is part of the ideological motivation behind the transition from institutionalized to decentralized psychiatry. Modern community mental health care considers social integration as vital for improving mental health. However, reports suggest that efforts to socially integrate people who suffer from mental health problems have not been as successful as anticipated. The aim of this study was to explore how people with mental health problems experience their ability to integrate socially into a community in central Norway. Three multistage focus groups, consisting of 17 people with mental health problems, were set up in two counties of different sizes. In this explorative study, data were analysed using a qualitative content analysis method. The participants experienced shame and fear of exclusion in their struggle to become integrated in the community. They had a sense of loneliness, had to struggle for equality and experienced being neglected. The days passed very slowly and they reported a lack of financial resources. They wanted to work or take part in other daytime activities and sought reciprocal relationships. In conclusion, those working in community mental health care need to ensure that people suffering from mental health problems experience a sense of belonging in the community, thus enabling them to develop a network and achieve social integration.

Adult↗

PubMed2026

Comprehensive in silico genomics analysis of global trends and host-specific emergence of aminoglycoside resistance in Staphylococcus aureus: a One-Health perspective.

BACKGROUND: Aminoglycosides remain clinically valuable against Staphylococcus aureus. Aminoglycoside resistance in S. aureus represents a critical One Health concern and is primarily driven by aminoglycoside-modifying enzymes (AMEs), which are frequently plasmid-encoded. Although regional studies have provided valuable insights, the global epidemiology of aminoglycoside resistance determinants remains poorly characterized because comprehensive data integrating human, animal, and environmental reservoirs are still lacking. This study addresses this gap by analyzing over 110,000 S. aureus genomes (2000-2025) to map the global resistome, quantify temporal and host-specific trends, and assess the association between genetic determinants and phenotypic resistance. METHODS: We performed a retrospective One Health meta-analysis of 110,309 S. aureus genomes collected between 2000 and 2025 from 128 countries. Genomes were quality-filtered and aminoglycoside resistance determinants were identified using NCBI AMRFinderPlus (v4.0.23). Multilocus sequence typing and host-source harmonization (Human, Animal, Environment, Unknown) enabled clonal and reservoir stratification. Temporal trends in gene prevalence and resistance burden were modeled with robust regression. Geographic and host-associated structuring of key genes was assessed via χ2 and enrichment tests. Machine-learning models (elastic-net, random forests, XGBoost) were benchmarked for minimum inhibitory concentration (MIC) prediction via nested cross-validation, with performance evaluated by mean absolute error, RMSE, and SHAP-based feature importance. All analyses were conducted in R and Python using publicly available, de-identified genomic data. RESULTS: Aminoglycoside resistance-associated genes were dominated by modifying enzyme determinants, with ant(6)-Ia, ant(9)-Ia, aph(3')-IIIa, sat4, aadD1, and aac(6')-Ie/aph(2'')-Ia occurring in 14-22% of isolates worldwide. Temporal analysis revealed significant declines in several major determinants, most notably ant(9)-Ia (-2.22 percentage points per year, p < 0.001), whereas apmA exhibited a non-significant decreasing trend in animal isolates. Host structuring was marked: human clinical isolates concentrated common determinants, while animal and environmental isolates harbored rare alleles (apmA, spw, str, spd). Geographic mapping confirmed near-universal distribution of common genes but focal restriction of rare ones. Publicly available phenotypic data indicated strong activity of amikacin, whereas gentamicin showed a distinct resistant subpopulation that closely corresponded with AME gene carriage. Genotype-phenotype analyses demonstrated strong concordance, with gene-rich complements predicting resistant MIC strata and absence of determinants predicting susceptibility. Analysis across different gene classes revealed frequent co-occurrence of aminoglycoside resistance genes with determinants from other classes, such as mecA, blaZ, and MLS_B, embedding them within multidrug-resistant (MDR) genomic contexts. CONCLUSION: Over 25 years, the prevalence of aminoglycoside resistance-associated genes in S. aureus has declined for several common determinants, while rare veterinary-linked alleles are emerging in animal isolates. Strong genotype-phenotype concordance supports genomic prediction for gentamicin and amikacin, where MIC data are available, although phenotypic confirmation remains essential. The frequent co-occurrence of aminoglycoside resistance genes with other antimicrobial resistance determinants indicates their integration within co-occurrence patterns of MDR genes, defined here as clusters of co-occurring resistance genes often carried on shared mobile genetic elements. These patterns highlight the need for integrated One Health surveillance combining clinical, veterinary, and environmental monitoring with plasmid-context resolution to anticipate emerging threats.

Aminoglycosides↗

PubMed2005

Toward semantic interoperability in home health care: formally representing OASIS items for integration into a concept-oriented terminology.

OBJECTIVE: The authors aimed to (1) formally represent OASIS-B1 concepts using the Logical Observation Identifiers, Names, and Codes (LOINC) semantic structure; (2) demonstrate integration of OASIS-B1 concepts into a concept-oriented terminology, the Medical Entities Dictionary (MED); (3) examine potential hierarchical structures within LOINC among OASIS-B1 and other nursing terms; and (4) illustrate a Web-based implementation for OASIS-B1 data entry using Dialogix, a software tool with a set of functions that supports complex data entry. DESIGN AND MEASUREMENTS: Two hundred nine OASIS-B1 items were dissected into the six elements of the LOINC semantic structure and then integrated into the MED hierarchy. Each OASIS-B1 term was matched to LOINC-coded nursing terms, Home Health Care Classification, the Omaha System, and the Sign and Symptom Check-List for Persons with HIV, and the extent of the match was judged based on a scale of 0 (no match) to 4 (exact match). OASIS-B1 terms were implemented as a Web-based survey using Dialogix. RESULTS: Of 209 terms, 204 were successfully dissected into the elements of the LOINC semantics structure and integrated into the MED with minor revisions of MED semantics. One hundred fifty-one OASIS-B1 terms were mapped to one or more of the LOINC-coded nursing terms. CONCLUSION: The LOINC semantic structure offers a standard way to add home health care data to a comprehensive patient record to facilitate data sharing for monitoring outcomes across sites and to further terminology management, decision support, and accurate information retrieval for evidence-based practice. The cross-mapping results support the possibility of a hierarchical structure of the OASIS-B1 concepts within nursing terminologies in the LOINC database.

Dictionaries, Medical as Topic↗

PubMed2005

Measuring tobacco dependence treatment outcomes: a perspective from the behavior change consortium.

The Behavior Change Consortium (BCC) served as a consortium of 15 National Institutes of Health-funded trials intended to link theories of health behavior change to outcomes related to improved diet, exercise, and/or tobacco cessation. Five sites developed and tested interventions aimed at changing tobacco use behaviors, and the remaining 10 focused on changing diet and/or physical activity. The BCC's tobacco dependence workgroup functioned to identify measures of tobacco use and dependence for use across the 15 BCC trials. The BCC tobacco intervention trials described herein were categorized by type of trial; theory(ies) on which each was based; and the "thickness," or intensity, of the intervention. Between-site differences across these parameters posed conceptual and analytic challenges for combining data for cross-site analyses, which were integral to the BCC mission of identifying mechanisms of health behavior change. The lessons learned by the BCC tobacco dependence workgroup regarding the measurement and analysis of tobacco outcomes among BCC trials are discussed, including the challenges and the opportunities regarding the preparation for cross-site analyses. The workgroup concludes that trials should report both assessment of a prolonged period of abstinence of 6 months or longer, in addition to the traditional 7-day point prevalence outcome.

Behavior Therapy↗

PubMed2005

Security infrastructure requirements for electronic health cards communication.

Communication and co-operation processes in the healthcare and welfare domain require a security infrastructure based on services describing status and relation of communicating principals as well as corresponding keys and attributes. Additional services provide trustworthy information on dynamic issues of communication and co-operation such as time and location of processes, workflow relations, integrity of archives and record systems, and system behaviour. To provide this communication and co-operation in a shared care environment, smart cards are widely used. Serving as storage media and portable application systems, patient data cards enable patient-controlled exchange and use of personal health data bound to specific purposes such as prescription and disease management. Additionally, patient status data such as the emergency data set or immunization may be stored in, and communicated by, patient data cards. Another deployment field of smart cards is their token functionality within a security framework, supporting basic security services such as identification, authentication, integrity, confidentiality, or accountability using cryptographic algorithms. In that context, keys, certificates, and card holder's attributes might be stored in the card as well. As an example, the German activity of introducing patient health cards and health professional cards is presented. Specification and enrolment aspects are on-going processes.

Communication↗

PubMed2004

New developments in museum-based informatics and applications in biodiversity analysis.

Information from natural history collections (NHCs) about the diversity, taxonomy and historical distributions of species worldwide is becoming increasingly available over the Internet. In light of this relatively new and rapidly increasing resource, we critically review its utility and limitations for addressing a diverse array of applications. When integrated with spatial environmental data, NHC data can be used to study a broad range of topics, from aspects of ecological and evolutionary theory, to applications in conservation, agriculture and human health. There are challenges inherent to using NHC data, such as taxonomic inaccuracies and biases in the spatial coverage of data, which require consideration. Promising research frontiers include the integration of NHC data with information from comparative genomics and phylogenetics, and stronger connections between the environmental analysis of NHC data and experimental and field-based tests of hypotheses.

Journal Article↗

PubMed2006

RETRACTED: Doxycycline alters the expression of matrix metalloproteases in the endometrial cells exposed to ovarian steroids and pro-inflammatory cytokine.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editors following an investigation by the Office of Research Integrity (ORI) at the Department of Health and Human Services. The investigation confirmed that the data presented has been falsified by the last author.

Anti-Bacterial Agents↗

PubMed2004

Improving surgical wound classification--why it matters.

Surgical wound classification is an important predictor of the risk of postoperative surgical site infections. Wound classification also is used to analyze clinical, economic, and educational outcomes in national reports on quality. As integral members of the health care team, nurses and physicians need to ensure that their data are correct, consistent, and reliable. This article delineates how one institution developed a multifaceted education program that resulted in a 26% improvement in the rate of correctly classified wounds. The education program provided regular feedback of results that helped identify opportunities for improvement on a widespread level.

General Surgery↗

PubMed1997

Specialist management: needs and benefits.

In increasingly cost-conscious, accountable and integrated health-care systems, the appropriate role of speciality care is under scrutiny. The data on the impact of rheumatologist care on outcomes in patients with rheumatoid arthritis (RA) is limited and inconclusive. However, based on a review of processes of care known to be related to superior patient outcomes it is suggested that rheumatologists should be the lead physicians in patients with RA. Rheumatologists but usually not generalists have the experience necessary to make an early diagnosis and to initiate appropriate disease modifying anti-rheumatic drug (DMARD) treatment. Rheumatologists have an in-depth understanding of new assessment methods to optimize medical treatment and to make best use of and co-ordinate multi-disciplinary care. To avoid delay of diagnosis and initiation of treatment, patients with polyarthritis should be referred to rheumatologists as soon as possible. This requires that access to rheumatologist care is guaranteed.

Arthritis, Rheumatoid↗

PubMed2003

Short-term temporal variation in PM2.5 mass and chemical composition during the Atlanta Supersite Experiment, 1999.

Measurements in urban Atlanta of transient aerosol events in which PM2.5 mass concentrations rapidly rise and fall over a period of 3-6 hr are reported. The data are based on new measurement techniques demonstrated at the U.S. Environmental Protection Agency (EPA) Atlanta Supersite Experiment in August 1999. These independent instruments for aerosol chemical speciation of NO3-, SO4(2-), NH4+, and organic and elemental carbon (OC and EC), reconstructed the observed hourly dry PM2.5 mass to within 20% or better. Data from the experiment indicated that transient PM2.5 events were ubiquitous in Atlanta and were typically characterized by a sudden increase of EC (soot) and OC in the early morning or SO4(2-) in the late afternoon. The frequent temporal decoupling of these events provides insights into their origins, suggesting mobile sources in metro Atlanta as the main contributor to early morning PM2.5 and more regionally located point SO2 sources for afternoon PM2.5 events. The transient events may also have health implications. New data suggest that short-term PM2.5 exposures may lead to adverse health effects. Standard integrated filter-based techniques used in PM2.5 compliance monitoring networks and in most past PM2.5 epidemiologic studies collect samples over 24-hr periods and thus are unable to capture these transient events. Moreover, health-effects studies that focus on daily PM2.5 mass alone cannot evaluate the health implications of the unique and variable chemical properties of these episodes.

Aerosols↗

PubMedDate not supplied

Development of a biomarker-based index for assessing the ecotoxic potential of aquatic sites.

The use of biochemical or physiological measurements as indicators of ecotoxicity is under constant development and has the advantage of delineating effects before the appearance of disease. However, these biomarkers are often part of a battery of tests, and it is difficult to integrate them together to gain an overall view of an organism's health. The aim of this study was to develop an index that could integrate the data derived from a battery of biomarkers for application to both spatial and temporal studies. Mya arenaria clams were collected at different sites along the Saguenay Fjord (Quebec, Canada). Six biomarkers were measured: metallothioneins, DNA strand breakage, lipid peroxidation, vitellin-like proteins, phagocytosis, and non-specific esterase activity in haemocytes. A biomarker index was obtained by summing the biomarker values expressed in term of classes. Classes were determined by a distribution-free approach derived from the theory of rough sets. The results of the spatial study show that the index values discriminated well between contaminated and uncontaminated sites. The highly polluted sites had the highest index values (18 compared with a reference value of 14). In the temporal study, the index was also able to highlight possible contamination-induced alterations, even though the interpretation of temporal variation is complicated by natural variations occurring throughout the year. A control chart approach is proposed for determining contaminated sites in both spatial and temporal surveys.

Animals↗

PubMed2006

Towards landscape design guidelines for reducing Lyme disease risk.

BACKGROUND: Incidence of Lyme disease in the US continues to grow. Low-density development is also increasing in endemic regions, raising questions about the relationship between development pattern and disease. This study sought to model Lyme disease incidence rate using quantitative, practical metrics of regional landscape pattern. The objective was to progress towards the development of design guidelines that may help minimize known threats to human and environmental health. METHODS: Ecological analysis was used to accommodate the integral landscape variables under study. Case data derived from passive surveillance reports across 12 counties in the US state of Maryland during 1996-2000; 2,137 cases were spatially referenced to residential addresses. Major roads were used to delineate 514 landscape analysis units from 0.002 to 580 km(2). RESULTS: The parameter that explained the most variation in incidence rate was the percentage of land-cover edge represented by the adjacency of forest and herbaceous cover [R(2) = 0.75; rate ratio = 1.34 (1.26-1.43); P < 0.0001]. Also highly significant was the percentage of the landscape in forest cover (cumulative R(2) = 0.82), which exhibited a quadratic relationship with incidence rate. Modelled relationships applied throughout the range of landscape sizes. CONCLUSIONS: Results begin to provide quantitative landscape design parameters for reducing casual peridomestic contact with tick and host habitat. The final model suggests that clustered forest and herbaceous cover, as opposed to high forest-herbaceous interspersion, would minimize Lyme disease risk in low-density residential areas. Higher-density development that precludes a large percentage of forest-herbaceous edge would also limit exposure.

Ecosystem↗

PubMed1997

The impact of ownership on health care services in HMOs.

Tests the theory that owners (hospital, physician, insurance) of vertically integrated health maintenance organizations (HMOs) might substitute towards production of their own specialty goods. Uses data from various sources in the USA. Determines the impact of ownership on factors such as average physician ambulatory services per enrollee and average hospital days per enrollee. Concludes that policymakers need to encourage the development of standard publicly available quality measures to intensify competition and eliminate excess profits accruing to provider-owners who substitute towards production of their own goods.

Catchment Area, Health↗

PubMed2003

Nurse-managed primary care: outcomes of a faculty practice network.

PURPOSE: To describe selected outcomes of nurse-managed primary care in a large faculty practice network (FPN) and to use guidelines proposed by the National Organization of Nurse Practitioner Faculties (NONPF) to evaluate those outcomes. DATA SOURCES: Mission and goals, nursing control, fiscal stability, health care outcomes, and faculty role integration were examined. CONCLUSIONS: Outcomes show that the FPN directly supports the mission and goals of the East Tennessee State University College of Nursing and is managed by nurse faculty members. The FPN uses earned revenue, grants, and contracts to maintain fiscal stability. Patients are highly satisfied with services, and external and internal audits find the quality of care to be excellent. Students are educated in the centers. Faculty members publish and present research and other scholarly work derived from the FPN. IMPLICATIONS FOR PRACTICE: This model demonstrates that faculty practice can work, can meet the evaluation components of guidelines of a major national organization, and can contribute to the improvement of health for vulnerable populations.

Adult↗

PubMed2002

A review of medical imaging informatics.

This review of medical imaging informatics is a survey of current developments in an exciting field. The focus is on informatics issues rather than traditional data processing and information systems, such as picture archiving and communications systems (PACS) and image processing and analysis systems. In this review, we address imaging informatics issues within the requirements of an informatics system defined by the American Medical Informatics Association. With these requirements as a framework, we review, in four sections: (1) Methods to present imaging and associated data without causing an overload, including image study summarization, content-based medical image retrieval, and natural language processing of text data. (2) Data modeling techniques to represent clinical data with focus on an image data model, including general-purpose time-based multimedia data models, health-care-specific data models, knowledge models, and problem-centric data models. (3) Methods to integrate medical data information from heterogeneous clinical data sources. Advances in centralized databases and mediated architectures are reviewed along with a discussion on our efforts at data integration based on peer-to-peer networking and shared file systems. (4) Visualization schemas to present imaging and clinical data: the large volume of medical data presents a daunting challenge for an efficient visualization paradigm. In this section we review current multimedia visualization methods including temporal modeling, problem-specific data organization, including our problem-centric, context and user-specific visualization interface.

Databases, Factual↗

PubMed2006

Social capital and health: civic engagement, community size, and recall of health messages.

OBJECTIVES: We explored the effects of community integration and pluralism on recall of cardiovascular disease health information messages. METHODS: With 1980-1983 data from the Minnesota Heart Health Program, we examined whether ties to community groups were associated with recall of health messages, and whether this relation was modified by size and degree of differentiation of the community. RESULTS: A higher level of civic engagement through ties to community groups was associated with better recall of health messages. Ties to community groups independently contributed to better message recall even after control for gender, education, and other variables. The moderating role of community size was non-significant but intriguing. CONCLUSIONS: Community group membership could increase exposure to health messages, providing a critical pathway for social capital to influence health promotion and, thus, public health outcomes.

Adult↗

PubMed1998

Substance use among nurses: differences between specialties.

OBJECTIVES: Valid data on factors that increase a health care worker's likelihood of substance use are integral in ensuring professional standards and quality health care for consumers. This study explored the association between nursing specialty and past-year substance use. METHODS: In an anonymous mailed survey, a balanced stratified sample of registered nurses (n = 4438) reported their use of marijuana, cocaine, and prescription-type drugs, as well as cigarette smoking and binge drinking. RESULTS: Prevalence of use of all substances was 32%. Rates varied by specialty, even when sociodemographics were controlled. Compared with nurses in women's health, pediatrics, and general practice, emergency nurses were 3.5 times as likely to use marijuana or cocaine (odds ratio [OR] = 3.5; 95% confidence interval [CI] = 1.5, 8.2); oncology and administration nurses were twice as likely to engage in binge drinking; and psychiatric nurses were most likely to smoke (OR = 2.4; 95% CI = 1.6, 3.8). No specialty differences appeared for prescription-type drug use. CONCLUSIONS: Certain nursing specialties were more likely than others to be associated with substance use. The differences were not explained by demographic characteristics. Inasmuch as a comparison of these results for nurses with prior work on physicians found considerable agreement by specialty, preventive initiatives should consider inter-disciplinary approaches to substance use education.

Adult↗