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PubMed1998

[Computer program "PANCREAS"].

Contemporary computer technology allows precise and fast large database analysis. Widespread and common use depends on appropriate, user friendly software, usually lacking in special medical applications. The aim of this work was to develop an integrated system designed to store, explore and analyze data of patients treated for pancreatic cancer. For that purpose the database administration system MS Visual Fox Pro 3.0 was used and special application, according to ISO 9000 series has been developed. The system works under MS Windows 95 with possibility of easy adaptation to MS Windows 3.11 or MS Windows NT by graphic user's interface. The system stores personal data, laboratory results, visual and histological analyses and information on treatment course and complications. However the system archives them and enables the preparation reports of according to individual and statistical needs. Help and security settings allow to work also for one not familiar with computer science.

Data Display↗
PubMed1998

Services for mentally ill homeless persons: street-level integration.

The key elements of a systems integration approach to delivery of human services are reviewed in terms of their application to services for mentally ill homeless persons. The example of a mental health outreach project illustrates the service- and systems-integrating influences of clinical case management with this population, and the ability of a "bottom-up" street-level approach to improve coordination and service accessibility for clients in general is discussed.

Community Health Workers↗
PubMed1997

The Cleveland Health Network: a new integrated delivery system.

CHN and its subsidiary CHN MCO have significantly impacted the Cleveland market place in the two years since their inception. CHN will continue to expand geographically with hospital and physician partners who are committed to providing quality care in the most cost-effective manner. Medical management will continue to be the central focus and over-riding success of the CHN MCO, making this organization extremely attractive to the payer market. The integrated CHN and its medical management focus could become a model for other integrated delivery systems. As the market place continues to experience an increase in managed care and more consolidation of healthcare providers (and in some cases, mergers with payers), more integrated delivery systems will emerge. Senior- and mid-level administrators and managers with operational responsibilities need to take into consideration how their patient access systems will need to be modified to meet the demands of managed care through the formation of integrated delivery systems. How patients access the systems is of critical importance in ensuring financial success, ease of access for the patient, and tracking of appropriate medical care.

Community Networks↗
PubMed1997

Geriatric assessment, coordinated case management, and information systems: an integrated model for delivery of services to nursing home residents.

Several interventions have been developed to minimize the effects of a fragmented health care system and improve services to older adults in long-term care settings. In the context of scarce specialized resources and expertise, this article describes Comprehensive Geriatric Assessment, Minimum Data Set, and Resident Assessment Protocols, the integration of which offers promise for effective evaluation and case management. The model's significance and potential benefits for targeting services to residents at risk for adverse outcomes are explored as components of an integrated information system for enhancing the care of nursing home residents.

Aged↗
PubMed2000

An integrated analysis and database system for full-length cDNA.

Annotation and database system of full-length cDNA sequences was developed. As the components of the system, ORF annotation system, functional annotation system based on database search results, mapping annotation system, and integrated retrieval and display system were developed. In the ORF annotation system integrated analyses using conventional tools are performed and useful retrieval interface using motif list are introduced. In the functional annotation system based on database search results, a new method that characterizes a given unknown cDNA was developed by using a profile of similarity level over words appearing in sequence database entries. In the mapping annotation system, we linked by similarity searches full-length cDNA sequences with database DNA sequences that are already mapped on chromosomes. By using these links, full-length cDNAs can be retrieved by the retrieval condition of physical mapping information. Genetic disease information mapped on the physical mapping site can also be displayed by this system. Furthermore, we constructed an integrated database system for these analyzed data, and thus enabled annotation and selection of full-length cDNAs from points of both gene function and mapping information.

Chromosome Mapping↗
PubMed2002

Performance of an integrated microoptical system for fluorescence detection in microfluidic systems.

This article presents a new integrated microfluidic/microoptic device designed for basic biochemical analysis. The microfluidic network is wet-etched in a Borofloat 33 (Pyrex) glass wafer and sealed by means of a second wafer. Unlike other similar microfluidic systems, elements of the detection system are realized with the help of microfabrication techniques and directly deposited on both sides of the microchemical chip. The detection system is composed of the combination of refractive circular or elliptical microlens arrays and chromium aperture arrays. The microfluidic channels are 60 microm wide and 25 microm deep. The elliptical microlenses have a major axis of 400 microm and a minor axis of 350 microm. The circular microlens diameters range from 280 microm to 350 microm. The apertures deposited on the outer chip surfaces are etched in a 3000-A-thick chromium layer. The overall thickness of this microchemical system is < 1.6 mm. A limit of detection of 3.3 nM for a Cy5 solution in phosphate buffer (pH 7.4) was demonstrated. The cross-talk signal measured between two adjacent microchannels with 1 mm pitch was < 1:5600, meaning that < or = 1.8 x 10(-4)% of the fluorescence light power emitted from one microchannel filled with a 50 microM Cy5 solution reaches the photodetector at the adjacent microchannel. This performance compares very well with that obtainable in microchemical chips using confocal fluorescence systems, taking differences in parameters, such as excitation power into microchannels, data acquisition rates, and signal filtering into account.

Journal Article↗
PubMed2004

Integrated endoscopy system for simultaneous imaging and spectroscopy for early lung cancer detection.

An integrated endoscopy system for simultaneous imaging and spectroscopy was developed to facilitate more accurate and convenient detection of early lung cancers. A specially designed three-CCD camera in combination with a dedicated light source permits capture of both white-light color images and tissue autofluorescence images without the need to switch between two different cameras. A mirror with an optical fiber at its center, placed at an interim imaging plane inside the camera unit, facilitates simultaneous imaging and spectroscopy measurements in either white-light reflectance mode or fluorescence mode. The system has been successfully tested in a clinic, demonstrating a practical approach to improve both diagnostic sensitivity and specificity at the same time.

Early Diagnosis↗
PubMed2005

Control of multidimensional integrable Hamiltonian systems.

In this paper, we study the controllability of a four-dimensional integrable Hamiltonian system that arises as a low-mode truncation of the nonlinear Schrödinger equation [Bishop, Phys. Lett. A 144, 17 (1990)]. The controller targets a solution of the uncontrolled dynamics. We show that in the limit of small control coupling, a Takens-Bogdanov bifurcation occurs at the control target. These results support our earlier claim that Takens-Bogdanov bifurcations will generically occur when dissipative control is applied to integrable Hamiltonian sytems. The presence of the Takens-Bogdanov bifurcation causes the control to be extremely sensitive to noise. Here, we implement an algorithm first developed in Kulp and Tracy [Phys. Rev. E 70, 016205 (2004)] to extract a subcritical noise threshold for the four-dimensional system.

Journal Article↗
PubMed2001

Differences in antimicrobial susceptibility among hospitals in an integrated health system.

We evaluated the differences in antimicrobial susceptibility among hospitals in three different integrated healthcare systems. Each system provided antibiogram-susceptibility reports from representative hospitals. Reports were analyzed for statistically significant differences between hospitals in a given system for nine important organisms. We found numerous significant interhospital differences in antimicrobial-susceptibility patterns within health systems. For this reason, the practice of combining antibiotic-susceptibility data into a systemwide antibiogram should be discouraged.

Delivery of Health Care, Integrated↗
PubMed2005

Twelve-month drug cost savings related to use of an electronic prescribing system with integrated decision support in primary care.

OBJECTIVE: We reported previously the results of a 6-month controlled trial in which the use of a commercially available electronic prescribing system with integrated clinical decision support and evidence-based message capability was associated with significantly lower primary care drug costs. The original study focused on new prescriptions, defined as claims for a medication that the patient had not received in the previous 12 months. The main objectives of this follow-up report were to (a) determine if the 6-month savings on new prescriptions were sustained during 12 months of follow-up, (b) evaluate the impact of the computerized decision support system (CDSS) on all pharmacy claims and per-member-per-month (PMPM) expenditures, and (c) evaluate the prescribing behaviors within 8 high-cost therapeutic categories that were frequently targeted by the electronic messages to prescribers to help verify that the drug cost savings were due to the recommendations in the electronic prescribing system. METHODS: Two database queries were performed to identify additional pharmacy claims data for all Network Health Plan patients who were cared for by the 38 primary care clinicians (32 physicians, 4 nurse practitioners, and 2 physician assistants) included in our original 6-month study. This follow-up analysis (a) identified all new prescription claims for the 2 groups of clinicians throughout the 12-month follow-up period (June 2002 through May 2003) and (b) assessed all pharmacy claims during the same 12-month period to provide more complete savings estimates and to examine between-group differences in PMPM expenditures. RESULTS: During 12 months of follow-up, clinicians using the electronic prescribing system continued to have lower prescription costs than the controls. Clinicians using the electronic prescribing system had average costs for 26,674 new prescriptions that were dollar 4.12 lower (95% confidence interval, dollar 1.53-dollar 6.71; P=0.003) and PMPM expenditures that were dollar 0.57 lower than expected based on the changes observed for 24,507 new prescriptions written by clinicians in the control group. The average drug cost savings on new prescriptions were dollar 482 per prescriber per month (PPPM), based upon prescription cost and dollar 465 PPPM based upon PMPM analysis. When all pharmacy claims (156,429) were analyzed, the intervention group.s average prescription cost was dollar 2.57 lower and their PMPM expenditures were dollar 1.07 lower than expected based on the changes observed in the control group. The average drug cost savings on all pharmacy claims were dollar 863 PPPM based on average prescription cost and dollar 873 PPPM based on PMPM analysis. The proportion of prescriptions for highcost drugs that were the target of the CDSS messages to prescribers was a relative 17.5% lower among the intervention group (35.8%) compared with the control group (43.4%; P=0.03). CONCLUSIONS: An electronic prescribing system with integrated decision support shifted prescribing behavior away from high-cost therapies and significantly lowered prescription drug costs. The savings associated with altered prescribing behavior offset the monthly subscription cost of the system.

Ambulatory Care Information Systems↗
PubMed1999

Outcome after severe head injury treated by an integrated trauma system.

OBJECTIVES: To describe outcome after treatment of severe head injury within an integrated trauma system. METHODS: A retrospective analysis of all patients with severe head injury admitted to the Royal London Hospital by the Helicopter Emergency Medical Service (HEMS) between 1991 and 1994. Type of injury was defined on initial computed tomography of the head and outcomes assessed 12 months after injury using the Glasgow outcome score. RESULTS: 6.5% of HEMS patients had long term severe disability (severe disability or persistent vegetative state on the outcome score); 34.5% made a good recovery. CONCLUSIONS: The concern that a large number of severely disabled long term survivors might result as a consequence of this system of trauma management is not confirmed. The case mix of severity of extracranial injuries in these patients makes comparison with other published series difficult, but these data fit the hypothesis that pre-hospital correction of hypoxia and hypotension after head injury improves outcome.

Abbreviated Injury Scale↗
PubMed2001

Just how integrated are integrated delivery systems? Results from a national survey.

This article examines three emergent processes in physician-hospital integrated delivery systems (IDSs). We find these processes are underdeveloped based on data gathered from a national sample of hospitals drawn from nine health care systems. These processes are also loosely coupled with the structures used to integrate physicians and hospitals, as well as with the environmental context in which they occur. Such loose coupling entails both advantages and disadvantages for IDSs.

Analysis of Variance↗
PubMed1986

Integrated epidemiological system for acute viral hepatitis in Italy (SEIEVA): description and preliminary results.

An integrated epidemiological system for the surveillance of acute viral hepatitis SEIEVA which linked notifications to available serology results and used a standard risk factor questionnaire is described. Results of over 1300 cases reported by 35 participating local health units (USL's) during the first 18 months of the programme are presented. Overall the annual reported incidence of acute viral hepatitis was 70 per 100,000. There were marked regional and age specific differences in the incidence of each type of viral hepatitis. The annual incidence per 100,000 of hepatitis A in southern children was 133 while in northern young adults the incidence of hepatitis B was 88 and hepatitis non-A non-B was 43. The possible roles of shellfish consumption in the transmission of non-A non-B hepatitis at all ages were highlighted.

Acute Disease↗
PubMed2005

Toward integration of systems biology formalism: the gene regulatory networks case.

We consider the problem of integrating different systems biology formalisms, namely, the process calculi based formalism, the modeling approach based on systems of differential equations, and the one relying on automata-like descriptions (and model checking). Specifically, we define automatic procedures for translating stochastic pi-calculus descriptions of gene regulatory networks to S-systems differential equations. Tools for extracting and reasoning on (approximate) solutions of S-systems have been recently developed in the literature, and can be exploited to establish a link with automata-based systems biology and model checking techniques.

Animals↗
PubMed1989

Computerized information sources in toxicology and their use in a poisons centre.

The increasing volume of calls received by a poisons centre, such as the National Poisons Unit, Guy's Hospital, London is placing the present information services under escalating pressure. Recent developments in the technologies used to store and manipulate data have resulted in a number of public and private computerized systems being made available. In order to maximize the benefit of the new technologies to a Poisons Centre Information Service it would be desirable to create an integrated system to link the currently unrelated systems. Such an integrated system would be capable of retrieving bibliographic information from bibliographic files similar to MEDLINE and EMBASE and data from source information files such as RTECS and ECDIN, with the user only having to make one enquiry. This paper examines the current position with regard to computerized information sources in toxicology and discusses how an integrated system might improve the efficiency of a poisons centre's information retrieval service and outlines some of the obstacles to the development of such a system.

Catalogs as Topic↗
PubMed1998

Providing strategic financial leadership for integrated delivery systems.

The increased complexity of financial and strategic decision making that accompanies the formation of integrated delivery systems (IDSs) challenges CFOs in these organizations to move beyond their traditional areas of responsibility. System CFOs need to assume a strategic leadership role in IDSs by taking steps to ensure that information required for high-level decision making is reliable, accessible, relevant, and placed in a context that enhances its usefulness.

Delivery of Health Care, Integrated↗
PubMed1998

Bankruptcy opportunities and pitfalls: strategies for restructuring and unwinding integrated delivery systems.

Many organizations in the healthcare field are facing issues regarding the "dis-integration" of previously assembled integrated delivery systems. In many situations, bankruptcy is the most effective effective means for pursuing this course of action. This article examines and explains the bankruptcy process, its applicability to an IDS, and strategies for dealing with the process.

Bankruptcy↗
PubMed1996

Primary care research from a health system perspective.

Vertically integrated systems of health care share a set of interests with academic health services researchers. These interests include questions about: the appropriate size and scope of the various system components; mechanisms for coordinating care across component parts; and "what works" in terms of clinical effectiveness within components. Primary care is a key system component in which all of these questions apply. Traditional research designs, however, are often difficult to apply in a health system context. The problems are (1) the rapid pace at which organizational change occurs, which renders some research findings obsolete before they are published, and (2) the difficulty in generalizing across a complex set of local environmental factors that vary from system to system. Useful research from a system perspective will either focus on problems of wide generalizability over place and time or be conducted according to new methodologies that offer much faster "cycle time" from design to findings.

Delivery of Health Care, Integrated↗