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Consignment purchasing saves money, improves cash flow, streamlines material management function.

The responsibility of materials managers has grown tremendously in the past few years as cost containment has become a top priority. Today materials managers are responsible not only for seeing that supplies are on hand, but also for contributing to the hospital's cost savings efforts. For Southeastern General, those goals were met through consignment purchasing. In fact, the ACCESS consignment program enabled the hospital to increase its linen inventory by three times the amount it had previously carried. Whereas Southeastern General's materials management department used to be caught with stockouts at the unpredictability of an antiquated laundry system, it is now the most reliable hospital in the area. It maintains a fully stocked inventory and is prepared for the unexpected. For example, many of the small hospitals in the region will borrow from Southeastern General when they are confronted with an immediate inventory crisis rather than wait the standard 15 to 30 days for shipment from suppliers. In this circumstance, Southeastern General provides the other hospitals with materials from its inventory and Medline bills the other hospitals directly for supplies used. Overall, Southeastern General has benefited from consignment through elimination of stockouts, price stability, improved cash flow, and time and labor savings. Above all, savings through the use of consignment directly impacts the hospital's bottom line.

Bedding and Linens↗

Internet course on total quality management.

The Internet provides new opportunities to information-based industries such as universities. If a vast majority of potential customers of our programs have access to the Internet, then it is conceivable that many universities will begin teaching Internet courses and that such courses could, in many cases, replace or at least augment existing face-to-face classroom activities. This paper is an account of one such course at Cleveland State University and the type of policy issues raised by the course at this institution.

Adult↗

New experimental and computational approaches to the analysis of gene expression.

Public and private EST (Expressed Sequence Tag) programs provide access to a large number of ESTs from a number of plant species, including Arabidopsis, corn, soybean, rice, wheat. In addition to the homology of each EST to genes in GenBank, information about homology to all other ESTs in the data base can be obtained. To estimate expression levels of genes represented in the DuPont EST data base we count the number of times each gene has been seen in different cDNA libraries, from different tissues, developmental stages or induction conditions. This quantitation of message levels is quite accurate for highly expressed messages and, unlike conventional Northern blots, allows comparison of expression levels between different genes. Lists of most highly expresses genes in different libraries can be compiled. Also, if EST data is available for cDNA libraries derived from different developmental stages, gene expression profiles across development can be assembled. We present an example of such a profile for soybean seed development. Gene expression data obtained from Electronic Northern analysis can be confirmed and extended beyond the realm of highly expressed genes by using high density DNA arrays. The ESTs identified as interesting can be arrayed on nylon or glass and probed with total labeled cDNA first strand from the tissue of interest. Two-color fluorescent labeling allows accurate mRNA ratio measurements. We are currently using the DNA array technology to study chemical induction of gene expression and the biosynthesis of oil, carbohydrate and protein in developing seeds.

Blotting, Northern↗

Virtual university applied to telesurgery: from teleeducation to telemanipulation.

UNLABELLED: PROBLEM/BACKGROUND: In order to improve patient care by minimal invasive surgery (MIS), we perfected a Virtual TeleSurgical University that allows for teleeducation, teleconcertation, surgical planning and telemanipulation, through new Virtual Reality and multimedia systems. TOOLS AND METHODS: The organization of this innovative school was federated around three major research programs. First, the TESUS program focused on the teletransmission of medical information, allowing for videoconferencing around the world and telementoring. Next, the WeBS-Surg program is a multimedia continuous surgical education system on internet, that allows for teleeducation and teleconcertation between world experts in MIS. Then, the MASTER program (Minimal Access Surgery by Telecommunications and Robotics) allowed the development of the third millenium Operating room. It included Virtual Reality systems that delineate automatically anatomical and pathological structures of a patients from him CT-scan, and that allow for an interactive surgical planning and force-feed-back simulation. It also included a telesurgical robot named Zeus controlled by surgeons through telemanipulation system. RESULTS: Tests and validation shows that all these systems improved all steps of the surgical procedure: preoperatively due to a better continuous education and a computer assisted surgical planning, and peroperatively due to teleconcertation, telementoring and telemanipulation systems. CONCLUSION: Revolutionary tools for minimal invasive surgery learning, planning and performing are all ready available. These tools represents the first prototype of the computer assisted tele-robotical surgery that will be the future of surgery.

Computer Simulation↗

Variability of position of the P2 glomerulus within a map of the mouse olfactory bulb.

Olfactory receptor neurons (ORNs) that express a common odorant receptor molecule target specific glomeruli in the olfactory bulb. We systematically assessed the location of the olfactory glomeruli that receive input from ORNs expressing P2 receptors in the P2-internal ribosome entry site-tau-lacZ mouse. We present a new mapping method that includes an Internet-accessible computer program for generating two- and three-dimensional maps of the glomerular sheet in the olfactory bulbs of mice. Cylindrical coordinates were used to define glomerular location: The coordinates were given as the anteroposterior (AP) distance parallel to the long axis of the bulb (rostrocaudal; RC) and angular measurements with origin defined by the remnant ependymal layer in the center of the granule cell layer in the bulb. Using this method, we can apply rigorous statistical methods to give objective estimates of position and variability. At the 95% confidence interval, the lateral P2 glomerulus lies at coordinates 1,008 microm +/- 306 microm AP x 146 degrees +/- 12 degrees, and the medial P2 glomerulus lies at 1,828 microm +/- 196 microm AP x 204 degrees +/- 8 degrees. We estimate that these coordinates encompass a domain containing 29 and 37 of the 1,800 glomeruli ( approximately 2%) for the lateral and medial glomeruli, respectively. Furthermore, the data reported here demonstrate that the rostrocaudal position of small P2 glomeruli is three times more variable than that of large glomeruli.

Animals↗

Children's health insurance programs: strategies for outreach and enrollment.

In tandem with Medicaid, the State Children's Health Insurance Program (CHIP) could cover most of the 11 million uninsured children in the United States. Nearly half of children without insurance are eligible for existing Medicaid programs, and an estimated 4 million more will be eligible under new CHIP rules. The key to moving toward universal coverage for children is outreach--making sure that every child who qualifies for the programs gains access to them. This issue of States of Health discusses some of the most effective strategies for achieving that goal.

Child↗

The pharmacology game.

This article gives instructions for designing a visually attractive, entertaining, faculty-led computer game for pharmacology review in a nursing education program. The game uses Microsoft PowerPoint, a presentation program that is inexpensive, easy to master, and widely available. Instructions for using Visual Basic for Applications to customize the game are included to allow tracking questions asked and the score of groups playing the game. The game can be easily adapted to material by specific nursing programs with access to PowerPoint.

Computer-Assisted Instruction↗

[Early intervention of specialist in children with bronchial asthma as a result of Prevention Program of Allergic Diseases in children].

Nowadays allergic diseases are one of the most important challenges in medicine because of healthful and economical consequences. Early diagnosis and correct treatment of allergic diseases, especially bronchial asthma have become a very important problem. For this purpose, prophylactic and treatment allergic programs are created. In this paper authors describe results of prophylactic program for allergic disease in children in Łódź district in years 2000-2001. Program improved access to specialists and allowed early diagnosis of bronchial asthma and other allergic diseases in children.

Asthma↗

[Trabeculectomy--long term results].

Goal of this paper was to analyze retrospectively and partially also prospectively the results of trabeculectomies (TE) performed at the Department of Ophthalmology of the University Hospital in Hradec Králové (Königgrätz), Czech Republic, EU, during the 1990-2000 period using the database program GLAUCOM Access 97. The authors did statistical analysis of 538 trabeculectomies performed as the first surgery for lowering the intraocular pressure (IOP) on the followed eye without peroperative use of antimetabolites or cytostatics with follow up period 1-10 years. The baseline criteria for the evaluation were changes of the IOP, visual acuity, and pharmacological treatment after the operation. The average age at the time of the surgery was 61.28 +/- 14.58 years. Surgeries were performed by 11 surgeons. During the follow-up period the IOP lowering effect of the surgery was demonstrated by lowering the average IOP values from 28.42 +/- 8.98 mm Hg to 16.53 +/- 5.93 mm Hg. In the first half of the follow-up period a slight improvement of the visual acuity was noticed, in the second one the visual acuity decreased. Pre-operative average visual acuity was 0.59 +/- 0.34, and at the end of the follow-up period it was 0.59 +/- 0.33. The surgery in glaucoma patients effectively lowered the average number of prescribed antiglaucomatics after TE from 1.92 +/- 0.83 to 0.89 +/- 0.80 drugs. Our evaluations clearly showed trabeculectomy is even in the presence of existence non-perforating surgeries the basic and relatively easy-to-perform IOP lowering technique with broad variety of indications, and with relatively low number of complications.

Female↗

Technology strategy and the balance sheet: 3 points to consider.

Most hospitals use technology strategically to differentiate themselves from their competition. The rapid rate of change in healthcare technologies necessitates development of a technology life-cycle management program. Having access to flexible sources of capital appropriate to each category of technology assets allows liabilities and assets to be matched on a "balanced" balance sheet.

Accounting↗

The patient safety institute demonstration project: a model for implementing a local health information infrastructure.

The increasing focus on patient safety has uncovered many unsafe conditions in the current US. healthcare system. One of the most glaring problems is the inability of a fragmented healthcare system to provide critical and timely clinical information at the point of care. The Institute of Medicine has called for the development of a National Health Information Infrastructure to rectify this deficiency. This NHII will be built on Local Health Information Infrastructures, or LHIIs. The Patient Safety Institute is a potential model for an LHII that was developed and implemented in Seattle using the Swedish Medical Centers and associated ambulatory clinics. This model was piloted and evaluated among 365 clinical users across three hospitals, three clinics, and family practice residency programs involving access of records of more than 5300 distinct patients within a five-month period and involved the collection of more than 23 million clinical data results. User responses revealed the technology was intuitive to learn, easy to use, easy to navigate, and helpful in clinical care. The PSI demonstration project has developed an approach to the creation and implementation of LHIIs that is potentially transferable to other local communities.

Diffusion of Innovation↗

Vaccines for prevention of human papillomavirus infection.

(1) High risk types of human papillomavirus (HPV) are the causal agents of cervical cancer. The prevention of HPV infection can reduce the incidence of this cancer. (2) Five phase II clinical trials have been published, and several large phase III trials are underway. (3) Trials have shown marked reductions in HPV infection. Most studies did not evaluate the effect of the vaccines on cancer because of lengthy time spans between HPV infection and the development of cancer. (4) Injection site pain, headache, and fatigue are the most common adverse events reported. (5) Important considerations include vaccine efficacy; acceptability; integration into existing vaccine schedules; cost; role of cervical screening programs; and access, particularly for people in the developing world.

Adolescent↗

The Kansas Health Education Training Center: caring for the underserved.

The State of Kansas was awarded Health Education Training Centers (HETC) DHHS/HRSA, BrHPr Federal funds for the first time in 2002 through 2005. The three-year grant award was under the leadership of the Nurse-Midwifery Education faculty of the University of Kansas (KU) School of Nursing. Federal objectives included: 1. To facilitate interdisciplinary clinical training for health professions students from nursing, medicine, and allied health at targeted underserved communities. 2. To deliver culturally appropriate health care information to underprivileged populations at targeted underserved communities. 3. To conduct continuing education activities for community health workers and health professionals serving vulnerable urban and rural populations. 4. To recruit and mentor high school students from disadvantaged populations to pursue health professions. This three-year state-wide program addressed access to quality health care for underprivileged and underserved populations in select communities to improve health status, through community-based care that is culturally competent, multidisciplinary, sensitive to needs of special populations and augmented by health professions students. This article provides a review of two selected community-based interventions in Sedgwick and Wyandotte counties (addressing BrHPr federal objectives one and two) implemented to enhance care for immigrant pregnant women and underserved patients diagnosed with diabetes, respectively. Also included is a review of literature related to the efficacy and utilization of community based health workers (CHWs) in caring for vulnerable populations.

Area Health Education Centers↗

Clinical Care Classification (CCC) System Charting Model.

This is a demonstration of the Clinical Care Classification (CCC) System Charting Model. The Model software is designed for any personal computer (PC) with Windows using Microsoft Office and Access. The program has been tested as efficient and effective for charting patient care plans using the CCC System's Standardized language following the nursing process. It is available for integration in any electronic health record (E.H.R) system.

Humans↗