Integrated system helps hospital improve quality.
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Hospitals, Community↗
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ISYMOD: a knowledge warehouse for the identification, assembly and analysis of bacterial integrated systems.
MOTIVATION: Complex biological functions emerge from interactions between proteins in stable supra-molecular assemblies and/or through transitory contacts. Most of the time protein partners of the assemblies are composed of one or several domains which exhibit different biochemical functions. Thus the study of cellular process requires the identification of different functional units and their integration in an interaction network; such complexes are referred to as integrated systems. In order to exploit with optimum efficiency the increased release of data, automated bioinformatics strategies are needed to identify, reconstruct and model such systems. For that purpose, we have developed a knowledge warehouse dedicated to the representation and acquisition of bacterial integrated systems involved in the exchange of the bacterial cell with its environment. RESULTS: ISYMOD is a knowledge warehouse that consistently integrates in the same environment the data and the methods used for their acquisition. This is achieved through the construction of (1) a domain knowledge base (DKB) devoted to the storage of the knowledge about the systems, their functional specificities, their partners and how they are related and (2) a methodological knowledge base (MKB) which depicts the task layout used to identify and reconstruct functional integrated systems. Instantiation of the DKB is obtained by solving the tasks of the MKB, whereas some tasks need instances of the DKB to be solved. AROM, an object-based knowledge representation system, has been used to design the DKB, and its task manager, AROMTasks, for developing the MKB. In this study two integrated systems, ABC transporters and two component systems, both involved in adaptation processes of a bacterial cell to its biotope, have been used to evaluate the feasibility of the approach.
ATP-Binding Cassette Transporters↗
Information systems integration in radiology.
Advances in information systems and technology in conjunction with outside forces requiring improved reporting are driving sweeping changes in the practice of radiology. In most academic radiology departments, there can be at least five separate information systems in daily use, a clinical picture archiving and communication system (PACS), a hospital information system (HIS), a radiology information system (RIS), a voice-recognition dictation system, and an electronic teaching/research file system. A PACS will have incomplete, incorrect, and inconsistent data if manual data entry is used. Correct routing of studies for diagnostic reporting and clinical review requires accurate information about the study type and the referring physician or service, often not easily entered manually. An HIS is a hospital-wide information system used to access patient information, reports from various services, and billing information. The RIS is typically a system specifically designed to place radiology orders, to receive interpretations, and to prepare bills for patients. Voice-recognition systems automatically transcribe the radiologist's dictation, eliminating transcription delays. Another system that is needed in a teaching hospital holds images and data for research and education. Integration of diverse systems must be performed to provide the functionality required by an electronic radiology department and the services it supports. Health Level 7 (HL7) and Digital Imaging and Communications in Medicine (DICOM) have enabled sharing of data among systems and can be used as the building blocks for truly integrated systems, but the user community and manufacturers need to specify the types of functionality needed to build clinically useful systems. Although technology development has produced the tools for interoperability for clinical and research/educational use, more work needs to be done to define the types of interaction that needs to be performed to realize the potential of these systems.
Computer Communication Networks↗
An integrated system for real-time detection of stiff masses with a single compression.
An integrated system is proposed for real-time imaging of tissue deformation in response to externally applied mechanical compression. The purpose of the system is to noninvasively detect tissue lesions based on their stiffness. The method includes applying external compression to the examined subject and acquiring magnetic resonance strain-encoded images using a real-time pulse sequence. In the proposed system, only a single compression is necessary to obtain a two-dimensional map of tissue deformation in a slice, eliminating the need for a complicated compressing device. The system was built and validated using phantom experiments.
Compressive Strength↗
The quest for integrated systems of care for frail older persons.
The challenge of an increasing elderly population, particularly with respect to frail older persons in need of long-term care, has coupled with ever-present budget constraints to make the financing, organization and delivery of elder care a major priority in North America, Europe and elsewhere in the developed world. Despite obvious cross-national differences in health and social care arrangements for the frail elderly, evidence of poorly coordinated services, disjointed care, less than optimum outcomes, system inefficiency, inadequate accountability, and uncontrolled costs can be found in all countries. There is a growing belief that more comprehensive approaches are needed to effectively address these problems. One such strategy, so-called integrated systems of care, shows great promise. The author critically examines the concept of integrated systems of care for the frail elderly, including the theoretical benefits and drawbacks of the model. At the policy and practice levels, descriptions are presented of, and evidence and lessons are summarized from a representative sample of such projects in the US (Social HMO and PACE), Canada (SIPA), Italy (Rovereto) and Australia (Coordinated Care Trials). The introduction of prototypes such as these raises a number of significant issues for policymakers, payers, providers, consumers and researchers. These are briefly examined in concluding remarks on the important potential of integrated systems of care for vulnerable older people.
Aged↗
Limitations of system integration in providing employment services for persons with mental illness.
This study assessed the influence of service systems integration on employment outcomes for persons with mental illness. A survey was sent to all 125 key program staff that worked for community mental health treatment agencies or vocational rehabilitation agencies. The survey found that referral and employment rates were low; but that these rates were related to characteristics of the interagency systems integration. Community mental health staff referred 448 individuals for employment services. Staff from vocational rehabilitation agencies accepted only 26% of these referrals and found work for just 11%; 7% were employed six months later. Also, 39% of respondents reported that the linkage agreement between their agencies was never established. This study suggests the need for more effective strategies for integrating mental health treatment and vocational rehabilitation systems.
Community Mental Health Services↗
Crafting new methods of systems integration.
A handful of pioneering organizations are using intranets in their systems integration efforts. They have concluded that intranets, when used in combination with interface engines, can "virtually integrate" data.
Computer Communication Networks↗
Systems integration: requirements for a fully functioning electronic radiology department.
Disparate computer-based information systems such as hospital information systems (HIS), radiology information systems (RIS), and picture archiving and communication systems (PACS) have been introduced into radiology departments at various times to meet specific operational objectives. Typically, these systems are implemented without an integration strategy. Systems integration, which optimizes integrity of data and labor savings, can be achieved by two general approaches. The first links the HIS to the PACS; the second involves interlinking of the HIS, RIS, and PACS, with the RIS as the central controlling system. Standardization in hardware, operating systems, and data base formats--which will allow true integration--is being addressed nationally and worldwide. Operational issues to resolve include ways to increase network capacity, control of data flow, and strategies for dealing with downtime. In the future, systems integration will enable prefetching, two-way interfaces, interfaces with digital dictation systems, and improved linkages with external digital input devices.
Computer Communication Networks↗
A chromosome integration system for stable gene transfer into Thermus flavus.
We have developed a chromosomal integration system for gene transfer into the extreme thermophile Thermus flavus. The system relies on integration at the site of leuB (3-isopropylmalate dehydrogenase) which was cloned from T. flavus. The leuB gene was insertionally inactivated in vitro with a thermostable kanamycin-resistance gene and transformed in single-copy into the chromosome of T. flavus on a plasmid vector. Gene replacement strains required leucine for growth, were stably kanamycin-resistant and could grow in the presence of kanamycin at temperatures up to 55 degrees C.
3-Isopropylmalate Dehydrogenase↗
In-situ nitrogen removal from the eutrophic water by microbial-plant integrated system.
OBJECTIVE: This study was to assess the influence of interaction of combination of immobilized nitrogen cycling bacteria (INCB) with aquatic macrophytes on nitrogen removal from the eutrophic waterbody, and to get insight into different mechanisms involved in nitrogen removal. METHODS: The aquatic macrophytes used include Eichhornia crassipes (summer-autumn floating macrophyte), Elodea nuttallii (winter-growing submerged macrophyte), and nitrogen cycling bacteria including ammonifying, nitrosating, nitrifying and denitrifying bacteria isolated from Taihu Lake. The immobilization carriers materials were made from hydrophilic monomers 2-hydroxyethyl acrylate (HEA) and hydrophobic 2-hydroxyethyl methylacrylate (HEMA). Two experiments were conducted to evaluate the roles of macrophytes combined with INCB on nitrogen removal from eutrophic water during different seasons. RESULTS: Eichhornia crassipes and Elodea nuttallii had different potentials in purification of eutrophic water. Floating macrophyte+bacteria (INCB) performed best in improving water quality (during the first experiment) and decreased total nitrogen (TN) by 70.2%, nitrite and ammonium by 92.2% and 50.9%, respectively, during the experimental period, when water transparency increased from 0.5 m to 1.8 m. When INCB was inoculated into the floating macrophyte system, the populations of nitrosating, nitrifying, and denitrifying bacteria increased by 1 to 2 orders of magnitude compared to the un-inoculated treatments, but ammonifying bacteria showed no obvious difference between different treatments. Lower values of chlorophyll a, COD(Mn), and pH were found in the microbial-plant integrated system, as compared to the control. Highest reduction in N was noted during the treatment with submerged macrophyte+INCB, being 26.1% for TN, 85.2% for nitrite, and 85.2% for ammonium at the end of 2nd experiment. And in the treatment, the populations of ammonifying, nitrosating, nitrifying, and denitrifying bacteria increased by 1 to 3 orders of magnitude, as compared to the un-inoculated treatments. Similar to the first experiment, higher water transparency and lower values of chlorophyll a, COD(Mn) and pH were observed in the plant+ INCB integrated system, as compared to other treatments. These results indicated that plant-microbe interaction showed beneficial effects on N removal from the eutrophic waterbody.
Biodegradation, Environmental↗
New governance for a new era: issues and challenges for integrating systems.
In this first part of a two-part column, Dr. Ruffin introduces seven key factors that will govern the operations of integrated systems. It is important to understand, he says, that, in the movement from a fee-for-service payment mechanism, in which the various elements of the health care field bill for their services independently and according to rules designed for their benefit, to an intregrated system, in which such independence can only lead to confusion in information systems, very substantial changes will be required in the governance of our health care institutions and organizations. In the second part of the column, Dr. Ruffin will elaborate on the seven factors that must be considered in the transition.
Capitation Fee↗
Highly integrated system solutions for air conditioning.
Starting with the air handling unit, new features concerning energy efficient air treatment in combination with optimisation of required space were presented. Strategic concepts for the supply of one or more operating suites with a modular based air handling system were discussed. The operating theatre ceiling itself, as a major part of the whole integrated system, is no longer a simple air outlet: additional functions have been added in so-called media-bridges, so that it has changed towards a medical apparatus serving as a daily tool for the physicians and the operating staff. Last and not least, the servicing of the whole system has become an integral part of the facility management with remote access to the main functions and controls. The results are understood to be the basis for a discussion with specialists from medical and hygienic disciplines as well as with technically orientated people representing the hospital and building-engineering.
Air Conditioning↗
The stability of mechanical calibration for a kV cone beam computed tomography system integrated with linear accelerator.
The geometric accuracy and precision of an image-guided treatment system were assessed. Image guidance is performed using an x-ray volume imaging (XVI) system integrated with a linear accelerator and treatment planning system. Using an amorphous silicon detector and x-ray tube, volumetric computed tomography images are reconstructed from kilovoltage radiographs by filtered backprojection. Image fusion and assessment of geometric targeting are supported by the treatment planning system. To assess the limiting accuracy and precision of image-guided treatment delivery, a rigid spherical target embedded in an opaque phantom was subjected to 21 treatment sessions over a three-month period. For each session, a volumetric data set was acquired and loaded directly into an active treatment planning session. Image fusion was used to ascertain the couch correction required to position the target at the prescribed iso-center. Corrections were validated independently using megavoltage electronic portal imaging to record the target position with respect to symmetric treatment beam apertures. An initial calibration cycle followed by repeated image-guidance sessions demonstrated the XVI system could be used to relocate an unambiguous object to within less than 1 mm of the prescribed location. Treatment could then proceed within the mechanical accuracy and precision of the delivery system. The calibration procedure maintained excellent spatial resolution and delivery precision over the duration of this study, while the linear accelerator was in routine clinical use. Based on these results, the mechanical accuracy and precision of the system are ideal for supporting high-precision localization and treatment of soft-tissue targets.
Calibration↗
Formal and informal systems of primary healthcare in an integrated system: evidence from the United Kingdom.
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Canada↗
Semiclassical Poincare map for integrable systems.
The semiclassical Poincare map is applied to integrable systems and in particular to the rectangular billiard. The zeroes of the functional determinant are shown to give EBK quantization. The transfer operator is explicitly unitary and finite, resulting in a finite expansion of the Euler product over periodic orbits.
Journal Article↗
An integrated system for real-time image guided cardiac catheter ablation.
Minimally invasive cardiac catheter ablation procedures require effective visualization of the relevant heart anatomy and electrophysiology (EP). In a typical ablation procedure, the visualization tools available to the cardiologist include bi-plane fluoroscopy, real-time ultrasound, and a coarse 3D model which gives a rough representation of cardiac anatomy and electrical activity. Recently, there has been increased interest in incorporating detailed, patient specific anatomical data into the cardiac ablation procedure. We are currently developing a prototype system which both integrates a patient specific, preoperative data model into the procedure as well as fuses the various visualization modalities (i.e. fluoroscopy, ultrasound, EP) into a single display. In this paper, we focus on two aspects of the prototype system. First, we describe the framework for integrating the various system components, including an efficient communication protocol. Second, using a simple two-chamber phantom of the heart, we demonstrate the ability to integrate preoperative data into the ablation procedure. This involves the registration and visualization of tracked catheter points within the cardiac chambers of the preoperative model.
Cardiac Catheterization↗
Designing a hospital information system: a comparison of interfaced and integrated systems.
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Computer Communication Networks↗
An interview with Sr. Monica Heeran. Enhancing quality through an integrated system. Interview by Sally D. McCulloch.
As President and Chief Executive Officer of PeaceHealth since July 1988, Sr. Monica F. Heeran, CSJP, presides over the management of seven health care facilities in Washington State, Oregon State, and Alaska. Additionally, she is the President and Chief Executive Officer of Sacred Heart Health System, a regional integrated health care system recently established to provide services for the underserved in Lane County, OR. 1993 marked the first full year of operation for the Sacred Heart Health Care System. The system, which unites several existing health care organizations into one cohesive group, was formed expressly to accomplish the goals of increasing access, enhancing quality, and lowering costs, and is a model health care provider for other areas of the country. Prior to assuming her current positions, Sr. Monica was the Administrator at Sacred Heart General Hospital, Oregon, for 15 years, preceded by terms as Administrator of Ketchikan General Hospital and St. Joseph Hospital, Bellingham. She received her Bachelor of Science Degree in Nursing from Seattle University and her Master's Degree in Hospital Administration from St. Louis University. Sr. Monica F. Heeran has served in the health care ministries of the Sisters of St. Joseph of Peace since 1950.
Chief Executive Officers, Hospital↗