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At least 937 records · Page 52Linked to original sources
PubMed1998

Cost analysis of hospital material management systems.

Integrated healthcare material management begins with manufactures of medical/surgical supplies, uses distributors and ends at the point of use at hospitals. Recent material management philosophies in the healthcare industry, such as just-in-time and stockless systems, are yet to be fully evaluated. In order to evaluate the cost effectiveness of each type of material management technique, a cost model for hospital materials management has been designed. Several case scenarios are analyzed and results are reported.

Cost Savings↗
PubMed2001

An integrated visualization system for surgical planning and guidance using image fusion and an open MR.

A surgical guidance and visualization system is presented, which uniquely integrates capabilities for data analysis and on-line interventional guidance into the setting of interventional MRI. Various pre-operative scans (T1- and T2-weighted MRI, MR angiography, and functional MRI (fMRI)) are fused and automatically aligned with the operating field of the interventional MR system. Both pre-surgical and intra-operative data may be segmented to generate three-dimensional surface models of key anatomical and functional structures. Models are combined in a three-dimensional scene along with reformatted slices that are driven by a tracked surgical device. Thus, pre-operative data augments interventional imaging to expedite tissue characterization and precise localization and targeting. As the surgery progresses, and anatomical changes subsequently reduce the relevance of pre-operative data, interventional data is refreshed for software navigation in true real time. The system has been applied in 45 neurosurgical cases and found to have beneficial utility for planning and guidance. J. Magn. Reson. Imaging 2001;13:967-975.

Adolescent↗
PubMedDate not supplied

Michigan health system launches integrated campaign using patient testimonials.

Spectrum Health System in Michigan recently launched The Right Decision campaign, which totes the system's heart center and cancer facilities. The effort is underway with aggressive print ads, television and radio spots, and Web site promotion. The 1,000-bed, acute-care system hopes to raise awareness of the heart and cancer centers through real-life patient testimonials.

Adult↗
PubMed1997

Interpretation of the Ws statistic: application to an integrated trauma system.

BACKGROUND: Comparison of trauma survival rates between institutions and reference data bases is hampered by different injury severity mixes. To overcome this, a standardized comparison using a stratified W statistic (Ws) has been proposed. Ws enables comparisons but does not represent actual survival rates at an institution. METHOD, DISCUSSION, AND RESULTS: This discussion paper uses, as an example, data from 632 patients with blunt injuries treated by an integrated trauma system comprising a helicopter emergency medical service and the Royal London Hospital. Using the United Kingdom Major Trauma Outcome Study as a reference data set, Ws is calculated and its usefulness discussed. The problem of overprediction of survival is discussed. A modification of the Ws method is used to allow for this and to estimate the actual survival rate. CONCLUSION: Ws is useful for comparison between centers. Trauma and Injury Severity Score methodology overpredicts survival in certain probability of survival intervals. Adjustment can be made to estimate the actual survival rate. When applied to an integrated trauma system, such adjustments demonstrate overall improved survival, most noticeable in a more severely injured subgroup.

Diagnosis-Related Groups↗
PubMed1984

Privacy Act of 1974; exempt record system--DHHS. Notice of proposed rulemaking.

The Assistant Secretary for Personnel Administration, through the Office of Personnel systems Integrity of the Department of Health and Human Services, by separate Federal Register notice is proposing alteration in the system of records entitled. "Management Information System Efficiency Report (MISER), HHS/OS/ASPER/OPSI", 09-90-0095. The Department intends to exempt portions of this system from certain provisions of the Privacy Act, 5 U.S.C. 552a. The proposed exemption is authorized by subsection (k)(2) of the Privacy ect, which applies to investigative materials compiled for law enforcement purposes. The Offices of Personnel Systems Integrity (OPSI) is authorised to gather information for personnel, legal and regulatory enforcement purposes under Title 5 U.S.C., Chapter 12. In order to maintain the integrity of the OPSI process of merit system and prohibited personnel practice complaints investigations, and to ensure that the Office of Personnel Systems Integrity will be able to obtain access to complete and accurate information, the Department proposes to exempt from the notification, access, correction, and amendment provisions of the Privacy Act those portions of Management Information System Efficiency Report (MISER) which contain personal information that would identify either a confidential source or an individual other than the complainant or subject of an investigation.

Civil Rights↗
PubMed2006

A participatory assessment of IS integration needs in maternity clinics using activity theory.

The design and development of information systems should focus on a wider context than merely one user group or organization. This is particularly the case with systems integration. A tentative description of the activity network, information needs, and user requirements should be acquired before any major changes are planned. Relatively rapid yet participatory methods are needed at this preliminary stage. In this article, we claim that activity theory offers a suitable framework for this. Subsequently, we present a qualitative study in which this approach was used, with focus on the practices of the information management within a maternity care activity network. The first aim was to elicit the most important integration needs in the existing information systems of Finnish maternity clinics. Secondly, we wanted to introduce a participatory approach to be utilized by the service-providing organizations themselves, rather than software companies or quality consultants. Data were collected in multi-professional group interviews. The results include information needs and communication problems as well as outlines for solutions in the systems integration of maternity clinics. Various tools of information management do not meet the concrete needs of health care work. Integration is needed on many levels, and it has to be adapted to the needs of numerous stakeholders. The applied activity-theoretical framework proved useful in describing such a multi-faceted system of information and its users. More research is needed on its wider applicability, particularly in situations where researchers are not active participants.

Access to Information↗
PubMed1998

Integrated defense system overlaps as a disease model: with examples for multiple chemical sensitivity.

The central nervous, immune, and endocrine systems communicate through multiple common messengers. Over evolutionary time, what may be termed integrated defense system(s) (IDS) have developed to coordinate these communications for specific contexts; these include the stress response, acute-phase response, nonspecific immune response, immune response to antigen, kindling, tolerance, time-dependent sensitization, neurogenic switching, and traumatic dissociation (TD). These IDSs are described and their overlap is examined. Three models of disease production are generated: damage, in which IDSs function incorrectly; inadequate/inappropriate, in which IDS response is outstripped by a changing context; and evolving/learning, in which the IDS learned response to a context is deemed pathologic. Mechanisms of multiple chemical sensitivity (MCS) are developed from several IDS disease models. Model 1A is pesticide damage to the central nervous system, overlapping with body chemical burdens, TD, and chronic zinc deficiency; model 1B is benzene disruption of interleukin-1, overlapping with childhood developmental windows and hapten-antigenic spreading; and model 1C is autoimmunity to immunoglobulin-G (IgG), overlapping with spreading to other IgG-inducers, sudden spreading of inciters, and food-contaminating chemicals. Model 2A is chemical and stress overload, including comparison with the susceptibility/sensitization/triggering/spreading model; model 2B is genetic mercury allergy, overlapping with: heavy metals/zinc displacement and childhood/gestational mercury exposures; and model 3 is MCS as evolution and learning. Remarks are offered on current MCS research. Problems with clinical measurement are suggested on the basis of IDS models. Large-sample patient self-report epidemiology is described as an alternative or addition to clinical biomarker and animal testing.

Acute-Phase Reaction↗
PubMed2005

Concurrent PET/CT with an integrated imaging system: intersociety dialogue from the joint working group of the American College of Radiology, the Society of Nuclear Medicine, and the Society of Computed Body Tomography and Magnetic Resonance.

Rapid advances in imaging technology are a challenge for health care professionals, who must determine how best to use these technologies to optimize patient care and outcomes. Hybrid imaging instrumentation, combining 2 or more new or existing technologies, each with its own separate history of clinical evolution, such as PET and CT, may be especially challenging. CT and PET provide complementary anatomic information and molecular information, respectively, with PET giving specificity to anatomic findings and CT offering precise localization of metabolic activity. Historically, the acquisition and interpretation of the 2 image sets have been performed separately and very often at different times and locales. Recently, integrated PET/CT systems have become available; these systems provide PET and CT images that are acquired nearly simultaneously and are capable of producing superimposed, coregistered images, greatly facilitating interpretation. As the implementation of this integrated technology has become more widespread in the setting of oncologic imaging, questions and concerns regarding equipment specifications, image acquisition protocols, supervision, interpretation, professional qualifications, and safety have arisen. This article summarizes the discussions and observations surrounding these issues by a collaborative working group consisting of representatives from the American College of Radiology, the Society of Nuclear Medicine, and the Society of Computed Body Tomography and Magnetic Resonance.

Humans↗
PubMed1993

The concept of an 'Integrated Survival System' for protection against the responses associated with immersion in cold water.

In this paper the concept of an 'Integrated Survival System' (ISS) is introduced and discussed in relation to the helicopter passenger/crew member, although the principles are equally applicable to many other types of user and circumstance requiring specialized protective clothing. The fundamental principles behind this concept are first, that the wearer should be given protection against all of the hazardous responses associated with immersion in cold water and secondly, that the individual components which make up the ISS must be compatible and complementary; they may also be interdependent.

Accidents, Aviation↗
PubMed1991

Facilitating discharge summary preparation in small hospitals.

This paper presents the result of a project to facilitate discharge summary preparation in small hospitals at low cost. Using an eye diseases hospital with twelve beds as an example, an integrated system for discharge summary preparation on a microcomputer platform was developed. The integrated system eliminated redundant data entry by a pull-type approach that automatically retrieved pertinent information from pre-existing records for inclusion in the discharge summary. Abbreviated and full versions of the discharge summary were generated with very little interactive time required of the physician or record clerk. The microcomputer implementation is described in this paper to illustrate the functionality and ease of this integrated system.

Costs and Cost Analysis↗
PubMed2006

Healthy steps in an integrated delivery system: child and parent outcomes at 30 months.

OBJECTIVE: To test the effects of the Healthy Steps for Young Children program (HS) (which supports parents managing children's developmental and behavioral issues)-with and without a prenatal component-on child health and development, parenting practices, and parental well-being. DESIGN: A concurrent comparison with clinic-level assignment to intervention or usual care status. Nested in the intervention arm, a randomized trial compared HS with and without a prenatal component. SETTING: Five primary care clinics in an integrated delivery system in the Pacific Northwest. PARTICIPANTS: A consecutive sample of 439 pregnant women (80% of eligible) were enrolled. Follow-up data were obtained for 78% when the child was 30 months old. Intervention Families in intervention clinics received HS services, including developmental and behavioral advice and risk factor screening. In addition, those randomized to prenatal services received 3 home visits during pregnancy. MAIN OUTCOME MEASURES: Assessed by telephone interview in the 3 domains of child health and development, parenting practices, and parental well-being. RESULTS: Intervention was associated with positive outcomes in timely well-child care, immunization rates, breastfeeding, television viewing, injury prevention, and discipline strategies. Prenatal initiation of services was associated with larger expressive vocabularies at age 24 months. Mothers who received the intervention reported more depressive symptoms, but there was no increase in the proportion with clinically significant depression. CONCLUSIONS: For members of an integrated delivery system, the HS intervention was associated with positive effects on children's health and parenting practices. There was little evidence of any additional benefit of HS services initiated during the prenatal period.

Accident Prevention↗
PubMed2003

Accuracy of the TRUGENE HIV-1 genotyping kit.

Drug resistance and poor virological responses are associated with well-characterized mutations in the viral reading frames that encode the proteins that are targeted by currently available antiretroviral drugs. An integrated system was developed that includes target gene amplification, DNA sequencing chemistry (TRUGENE HIV-1 Genotyping Kit), and hardware and interpretative software (the OpenGene DNA Sequencing System) for detection of mutations in the human immunodeficiency virus type 1 (HIV-1) protease and reverse transcriptase sequences. The integrated system incorporates reverse transcription-PCR from extracted HIV-1 RNA, a coupled amplification and sequencing step (CLIP), polyacrylamide gel electrophoresis, semiautomated analysis of data, and generation of an interpretative report. To assess the accuracy and robustness of the assay system, 270 coded plasma specimens derived from nine patients were sent to six laboratories for blinded analysis. All specimens contained HIV-1 subtype B viruses. Results of 270 independent assays were compared to "gold standard" consensus sequences of the virus populations determined by sequence analysis of 16 to 20 clones of viral DNA amplicons derived from two independent PCRs using primers not used in the kit. The accuracy of the integrated system for nucleotide base identification was 98.7%, and the accuracy for codon identification at 54 sites associated with drug resistance was 97.6%. In a separate analysis of plasma spiked with infectious molecular clones, the assay reproducibly detected all 72 different drug resistance mutations that were evaluated. There were no significant differences in accuracy between laboratories, between technologists, between kit lots, or between days. This integrated assay system for the detection of HIV-1 drug resistance mutations has a high degree of accuracy and reproducibility in several laboratories.

Anti-HIV Agents↗
PubMedDate not supplied

Communication system facilitates integrated patient-centred care.

At the Wellesley Hospital in Toronto, a unit designed to house patients awaiting placement developed a communication system to facilitate integrated patient-centred care. The system included a patient and family orientation brochure, an interdisciplinary kardex and an interdisciplinary patient goal sheet. Patient care improved under the new system, as staff was easily able to access current assessment data and establish and document integrated patient goals. Other outcomes included improved communication among team members, enhanced team member accountability, cohesiveness and satisfaction, and increased patient and family satisfaction.

Communication↗
PubMedDate not supplied

A system for integrated measurement of ventilator settings, lung volume change and blood gases during high-frequency oscillatory ventilation.

To describe and validate a system for integrated measurement of ventilator settings and dependent physiological variables during high-frequency oscillatory ventilation (HFOV). A custom interface was built for data acquisition. Lung volume change was determined by respirator inductive plethysmography (RIP), modified to sampling rates of 140 Hz. Blood gas analysis was obtained using a continuous intra-arterial blood gas monitoring system. FIO2 was measured by means of an electrochemical sensor. Pressure at the airway opening and trachea (microtip transducer) were sampled. The data acquired were sent to a laptop computer for analysis, display and storage. The system was tested during a lung recruitment procedure in an animal model of respiratory distress. Linearity of the RIP was checked by gas volume injection using a supersyringe. The system operated successfully. Agreement between RIP-measured volume with injected volume was excellent; bias was 5 ml; limits of agreement were 1-9 ml. Graphs were obtained, showing the relationship between imposed mean airway pressure and lung volume change, and oxygenation. The integration of ventilator settings and dependent physiological variables may provide useful information for clinical, instructional and research application.

Animals↗
PubMedDate not supplied

Hospital-physician relationships in the integrated delivery system: an ethical analysis.

The need to compete for managed care contracts is causing hospitals and physicians to dramatically change how they do business with each other. Most significant is the formation of integrated delivery health-care systems. The emergence of these systems creates an enhanced need for physicians and administrators to better understand what the other actually does. This article examines the new health-care marketplace from both perspectives and how integrated delivery systems affect individual and community patient care, and it offers guidelines for effective hospital-physician relationships within integrated delivery systems.

Cost Control↗
PubMed1999

Implications of health promotion for integrated health systems.

Summarizes key conclusions and recommendations found in the Centre for Health Promotion's position paper on the role of health promotion within integrated health systems. The original position paper was based on advice received from a working group of organizations and practitioners interested in health promotion. This group was established to formulate recommendations for the government of the Province of Ontario, which was in the process of reforming its system of health care delivery.

Community Participation↗