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PubMed2004

The EchoMap System: online integration of intracoronary ultrasound and Doppler images into angiographic images during cardiac catheterization. Influence on radiation exposure and procedure parameters.

The EchoMap system allows online integration of intravascular ultrasound (IVUS) and intracoronary Doppler (ICD) images into angiographic images during catheterization, providing exact localization of the IVUS transducer and the ICD wire tip position. Although this is a major advance, the use of the system could lead to more angiographic documentation sequences and enhanced radiation exposure. We investigated the influence of system use on radiation and procedure parameters. During a 22-month period, 794 patients underwent coronary angiography with simultaneous performance of IVUS and/or ICD. The EchoMap system was applied in 392 patients ("EchoMap group"), the remaining 402 patients formed the "No-EchoMap group." Multivariate regression analysis showed no independent association between the use of EchoMap and fluoroscopy time (14.7 +/- 8.5 minutes in the EchoMap group vs 14.5 +/- 10 minutes in the No-EchoMap group, P = NS) or dose area product (7589 +/- 4916 in the EchoMap group vs 7031 +/- 5434 cGy x cm(2), P = NS). EchoMap use was significantly associated with a moderate increase in contrast media amount (392 +/- 162 in the EchoMap vs 356 +/- 155 mL in the No-EchoMap group, P = 0.001). In conclusion, the use of the EchoMap system had no significant influence on radiation exposure during cardiac catheterization, whereas it was associated with a moderate increase in contrast media amount.

Cardiac Catheterization↗

PubMed1995

Building a medical multimedia database system to integrate clinical information: an application of high-performance computing and communications technology.

The rapid growth of diagnostic-imaging technologies over the past two decades has dramatically increased the amount of nontextual data generated in clinical medicine. The architecture of traditional, text-oriented, clinical information systems has made the integration of digitized clinical images with the patient record problematic. Systems for the classification, retrieval, and integration of clinical images are in their infancy. Recent advances in high-performance computing, imaging, and networking technology now make it technologically and economically feasible to develop an integrated, multimedia, electronic patient record. As part of The National Library of Medicine's Biomedical Applications of High-Performance Computing and Communications program, we plan to develop Image Engine, a prototype microcomputer-based system for the storage, retrieval, integration, and sharing of a wide range of clinically important digital images. Images stored in the Image Engine database will be indexed and organized using the Unified Medical Language System Metathesaurus and will be dynamically linked to data in a text-based, clinical information system. We will evaluate Image Engine by initially implementing it in three clinical domains (oncology, gastroenterology, and clinical pathology) at the University of Pittsburgh Medical Center.

Abstracting and Indexing↗

PubMed1988

An integrated microcomputer system using immobilized cellular electrodes for drug screening.

Biosensors based on immobilized microbial cells were developed for drug screening in our laboratory. Compared with the conventional methods such as diffusion and dilution tests, biosensors have been demonstrated to be superior in sensitivity and require much shorter screening time. An integrated microcomputer system has been developed for data acquisition, database management, and mode of action estimation, which automates the screening processes and reduces the labor requirements significantly.

Anti-Bacterial Agents↗

PubMedDate not supplied

Integrated software system for improving medical equipment management.

The evolution of biomedical technology has led to an extraordinary use of medical devices in health care delivery. During the last decade, clinical engineering departments (CEDs) turned toward computerization and application of specific software systems for medical equipment management in order to improve their services and monitor outcomes. Recently, much emphasis has been given to patient safety. Through its Medical Device Directives, the European Union has required all member nations to use a vigilance system to prevent the reoccurrence of adverse events that could lead to injuries or death of patients or personnel as a result of equipment malfunction or improper use. The World Health Organization also has made this issue a high priority and has prepared a number of actions and recommendations. In the present workplace, a new integrated, Windows-oriented system is proposed, addressing all tasks of CEDs but also offering a global approach to their management needs, including vigilance. The system architecture is based on a star model, consisting of a central core module and peripheral units. Its development has been based on the integration of 3 software modules, each one addressing specific predefined tasks. The main features of this system include equipment acquisition and replacement management, inventory archiving and monitoring, follow up on scheduled maintenance, corrective maintenance, user training, data analysis, and reports. It also incorporates vigilance monitoring and information exchange for adverse events, together with a specific application for quality-control procedures. The system offers clinical engineers the ability to monitor and evaluate the quality and cost-effectiveness of the service provided by means of quality and cost indicators. Particular emphasis has been placed on the use of harmonized standards with regard to medical device nomenclature and classification. The system's practical applications have been demonstrated through a pilot evaluation trial.

Database Management Systems↗

PubMed1995

Activity-based costing for integrated delivery systems.

The paradigm shift toward managed care is fueling new cost-finding demands. More sophisticated methods are emerging to meet these demands. Foremost among the new methods is activity-based costing (ABC). ABC is designed to eliminate cross-subsidies between products or services. Because costs are traced by activities across departments and cost centers, costs can also be traced by activities across integrated delivery systems (IDSs). The methodology makes ABC very applicable to combinations of providers including chains, affiliated groups, and IDS participants.

Cost Allocation↗

PubMed2003

Web presence of an integrated delivery system at year one: lessons learned.

The log analysis of a web site can be used to guide performance improvement. Log analysis identifies which resources on a website are often accessed and those that are not. A log analysis can provide cost justification for a corporate web presence. We describe the log analysis of a large integrated delivery system in New York City from its launch May 1, 2001, through April 30, 2002. During this first year there were 428753 sessions with 1322153 page views. An analysis of page views, exclusive of the default home page, revealed that the pages most frequently visited were related to job opportunities (22.4%, 120086 of 428753), general information ('About') (8.5%, 45355), St. Vincent's Hospital Manhattan (8.3%, 44630), graduate medical education and allied health (8.1%, 43317), facilities (7.2%, 38677), web site search (6.4%, 34322), and physician finder (4.3%, 22910). The web site facilitated 1,980 online job applications. Health information received 15356 page views from 1793 visits. The re-design of the site for year 2 promoted the more frequently selected links, flattened the navigational architecture, and enabled access to all web pages within two to three mouse clicks of the home page. Lessons learned in the process of developing and maintaing a health care organization web site are shared in the case study.

Community Participation↗

PubMed1989

Transformation of Mycoplasma pulmonis: demonstration of homologous recombination, introduction of cloned genes, and preliminary description of an integrating shuttle system.

The transposons Tn916 and Tn4001 and a series of integrating plasmids derived from their antibiotic resistance genes were used to examine polyethylene glycol-mediated transformation of Mycoplasma pulmonis. Under optimal conditions, Tn916 and Tn4001 could be introduced into M. pulmonis at frequencies of 1 x 10(-6) and 5 x 10(-5) per CFU, respectively. Integrating plasmids were constructed with the cloned antibiotic resistance determinants of Tn916 and Tn4001, a pMB1-derived plasmid replicon, and mycoplasmal chromosomal DNA and were used to examine recombinational events after transformation into M. pulmonis. Under optimal conditions, chromosomal integrations could be recovered at a frequency of 1 x 10(-4) to 1 x 10(-6) per CFU, depending on the size and nature of the chromosomal insert and the parental plasmid. Integrated plasmids were stable in the absence of selection and could be rescued in Escherichia coli along with adjacent mycoplasma DNA. These studies provide the first direct evidence of a recombination system in the Mollicutes and describe the first E. coli-M. pulmonis shuttle vectors.

Blotting, Southern↗

PubMed1993

Evaluation of mating systems involving five breeds for integrated beef production systems: IV. Accounting for variability and genetic trends.

Computer models were used to simulate integrated cow-calf-feedlot production systems. Angus (A), Charolais (C), Hereford (H), Limousin (L), and Simmental (S) purebreds and two- and three-breed rotational crossbreds were included. Models were deterministic and based on data reported primarily from the 1970s. Variation in carcass weights were determined to predict distributions of carcass weights and values for 272- to 318-kg carcasses. Data were updated to a 1984 base by increasing birth, weaning, yearling, and mature weights to account for genetic trends within breeds. Two slaughter end points were considered: 288-kg carcass weight and low Choice grade. At low Choice grade, accounting for variation in carcass weights around the 272- to 318-kg target weight increased the estimated efficiency of A and AH crosses (input costs/carcass value), whereas at the 288-kg end point, efficiency rankings among other breed combinations were relatively unchanged. Including genetic trends resulted in increased estimated efficiencies among breed combinations with previously underweight carcasses at low Choice (A and AH), measured either as input costs/carcass weight or lean weight values. Within breeds, accounting for genetic trends and variation for weights caused breeds to be ranked differently when evaluated at low Choice.

Animals↗

PubMed2006

Purdue ionomics information management system. An integrated functional genomics platform.

The advent of high-throughput phenotyping technologies has created a deluge of information that is difficult to deal with without the appropriate data management tools. These data management tools should integrate defined workflow controls for genomic-scale data acquisition and validation, data storage and retrieval, and data analysis, indexed around the genomic information of the organism of interest. To maximize the impact of these large datasets, it is critical that they are rapidly disseminated to the broader research community, allowing open access for data mining and discovery. We describe here a system that incorporates such functionalities developed around the Purdue University high-throughput ionomics phenotyping platform. The Purdue Ionomics Information Management System (PiiMS) provides integrated workflow control, data storage, and analysis to facilitate high-throughput data acquisition, along with integrated tools for data search, retrieval, and visualization for hypothesis development. PiiMS is deployed as a World Wide Web-enabled system, allowing for integration of distributed workflow processes and open access to raw data for analysis by numerous laboratories. PiiMS currently contains data on shoot concentrations of P, Ca, K, Mg, Cu, Fe, Zn, Mn, Co, Ni, B, Se, Mo, Na, As, and Cd in over 60,000 shoot tissue samples of Arabidopsis (Arabidopsis thaliana), including ethyl methanesulfonate, fast-neutron and defined T-DNA mutants, and natural accession and populations of recombinant inbred lines from over 800 separate experiments, representing over 1,000,000 fully quantitative elemental concentrations. PiiMS is accessible at www.purdue.edu/dp/ionomics.

Arabidopsis↗

PubMedDate not supplied

Improving clinical effectiveness in an integrated care delivery system.

HealthEast, an integrated care delivery system based in St. Paul, MN, established a care management program in 1993. At HealthEast, care management is defined as "an interdisciplinary process of coordinating client-centered services across the continuum of care to achieve quality and cost-effective outcomes." The program included establishing a collaborative practice model that was used to drive the organization's improvement efforts. The use of this model has been instrumental in achieving significant improvements in financial and clinical performance. As a result, HealthEast received a leadership award for "Improving Clinical Effectiveness within a Healthcare System" from VHA, Inc., a nationwide membership alliance of approximately 1,700 community healthcare organizations.

Benchmarking↗

PubMed1986

An integrated software system for microcomputer management of recombinant DNA data.

A database-oriented system (pCP123) is described for the manipulation of recombinant DNA data. This system was developed within the context of an integrated software package with spreadsheet, database, graphing and programming capabilities. The system includes two databases, one of sites and another of regions, coordinately handled by a series of macro-programs operated from four user-define menus. A distinctive feature of the system is the possibility of handling both ends of defined functional or structural regions in situations of simulated deletions or insertions.

Computers↗

PubMed1998

Experience implementing a DICOM 3.0 multivendor teleradiology network.

OBJECTIVE: The ISIS Center at Georgetown University received a grant from the U.S. Army to act as systems integrator for a project to design, develop, and implement a commercial off-the-shelf teleradiology system to support the U.S. troops in Bosnia-Herzegovina. The goal of the project was to minimize troop movement while providing primary diagnosis to military personnel. This paper focuses on Digital Imaging Communications in Medicine (DICOM) 3.0 related issues that arose from this type of teleradiology implementation. The objective is to show that using the DICOM standard provides a good starting point for systems integration but is not a plug-and-play operation. METHODS: Systems were purchased that were based on the DICOM 3.0 standard. The modalities implemented in this effort were computed radiography (CR), computed tomography (CT), film digitization (FD), and ultrasonography (US). Dry laser printing and multiple-display workstations were critical components of this network. The modalities and output devices were integrated using the DICOM 3.0 standard. All image acquisition from the modalities is directly to a workstation. The workstation distributes the images to other local and remote workstations, to the dry laser printer, and to other vendors' workstations using the DICOM 3.0 standard. All systems were integrated and tested prior to deployment or purchase. Local and wide area networking were also tested prior to implementation of the deployable radiology network. RESULTS: The results of the integration of the multivendor network were positive. Eventually, all vendors' systems did communicate. Software configuration and operational changes were made to many systems in order to facilitate this communication. Often, software fixes or patches were provided by a vendor to modify their DICOM 3.0 implementation to allow better communications with another vendor's system. All systems were commercially available, and any modifications or changes provided became part of the vendor's commercially available package. CONCLUSION: Seven DICOM interfaces were implemented for this project, and none was achieved without modification of configuration files, changes or patches in vendor software, or operational changes. Some of the problems encountered included missing or ignored required data elements, padding of data values, unique study identifiers (UID), and the use of application entity titles. The difficulties with multivendor connectivity lie in the understanding and interpretation of standards such as DICOM 3.0. The success of this network proves that these problems can be overcome and a clinically successful network implemented utilizing multiple vendors' systems.

Computer Communication Networks↗

PubMed1995

An integrated delivery systems review: common problems to be addressed.

The most critical element in developing a successful IDS is identifying the needs and goals of the parties within the context of the realities of their local health care market. It is therefore unwise to select the structure of a proposed IDS until this process has been completed. An honest goals assessment might result in the immediate formation of a PHO, MSO, medical foundation or other formal IDS, or might alternatively point in the direction of something much less structured, such as a joint marketing contractual arrangement (sometimes called a "PHA"), which can be relatively inexpensive to implement and can provide a fairly immediate response to quickly changing market conditions. Some organizations might even decide to utilize a number of different IDS vehicles in order to offer physicians a menu of affiliation options. The legal issues that arise when forming an IDS can almost always be dealt with in a reasonable manner. The real key to success is entering into integration discussions with an open mind, rather than a preconceived commitment to a particular integration.

Hospital-Physician Joint Ventures↗

PubMed2002

An intelligent sales forecasting system through integration of artificial neural networks and fuzzy neural networks with fuzzy weight elimination.

Sales forecasting plays a very prominent role in business strategy. Numerous investigations addressing this problem have generally employed statistical methods, such as regression or autoregressive and moving average (ARMA). However, sales forecasting is very complicated owing to influence by internal and external environments. Recently, artificial neural networks (ANNs) have also been applied in sales forecasting since their promising performances in the areas of control and pattern recognition. However, further improvement is still necessary since unique circumstances, e.g. promotion, cause a sudden change in the sales pattern. Thus, this study utilizes a proposed fuzzy neural network (FNN), which is able to eliminate the unimportant weights, for the sake of learning fuzzy IF-THEN rules obtained from the marketing experts with respect to promotion. The result from FNN is further integrated with the time series data through an ANN. Both the simulated and real-world problem results show that FNN with weight elimination can have lower training error compared with the regular FNN. Besides, real-world problem results also indicate that the proposed estimation system outperforms the conventional statistical method and single ANN in accuracy.

Algorithms↗

PubMed1999

An integrated decision support system for diagnosing and managing patients with community-acquired pneumonia.

Decision support systems that integrate guidelines have become popular applications to reduce variation and deliver cost-effective care. However, adverse characteristics of decision support systems, such as additional and time-consuming data entry or manually identifying eligible patients, result in a "behavioral bottleneck" that prevents decision support systems to become part of the clinical routine. This paper describes the design and the implementation of an integrated decision support system that explores a novel approach for bypassing the behavioral bottleneck. The real-time decision support system does not require health care providers to enter additional data and consists of a diagnostic and a management component.

Bayes Theorem↗

PubMed2002

Contemporary developmental theory and adolescence: developmental systems and applied developmental science.

PURPOSE: To discuss developmental systems models of human development and explain how they offer a productive frame for research, policies, and programs aimed at understanding adolescents' development and enhancing their health and positive development. Contemporary developmental theory stresses that the multiple levels of organization involved in human life (ranging from biology through culture, the natural and designed ecology, and history) are systemically integrated across ontogeny. Relations within this developmental system are the focus of developmental analysis and application. METHODS: The key features of developmental systems theories are reviewed, and their use for framing scholarship about and applications for improving adolescent development are assessed. RESULTS: We demonstrate the potential of contemporary developmental theory for understanding the character and dynamics of adolescent development and for using this knowledge for the design of effective policies and programs that promote positive youth development. CONCLUSIONS: An adequate and sufficient science of adolescent development, and one that is able to help in the development of successful policies and programs for youth, must integratively study the relations between individuals and contexts in an integrated, systemic, and temporal manner.

Adolescent↗

PubMed1999

Neuronavigation in intraoperative MRI.

OBJECTIVE: We describe the development and implementation of an image-guided surgical system combining the best features of conventional frameless stereotactic systems and the recently developed superconductive vertically configured intraoperative magnetic resonance scanner. The incorporation of intraoperatively updated magnetic resonance imaging (MRI) data sets into the neuronavigation computer overcomes one of the main disadvantages of these systems, i.e., intraoperative brain shift. METHODS: The integrated system consists of a 0.5-T MRI scanner (Signa SP General Electric Medical Systems, Milwaukee, WI), a neuronavigation computer with associated software (OTS Radionics, Burlington, MA), and an emulation program linking the two. The scanner has a 60-cm-wide vertical gap where both imaging and surgery are conducted, in-bore infrared linear cameras and monitors for interactive surgical neuronavigation, and flexible surface coils specially designed for surgery. RESULTS: Phantom studies showed navigational accuracy to be better than that obtained using conventional preoperative images and surface markers for patient registration. Our initial 17 cases using this integrated system comprised 16 craniotomies and one biopsy, and demonstrated decreased operative duration, greater frequency of interactive image guidance utilization, and better assessment of the progress of surgery compared to the cases previously done in the intraoperative MRI. CONCLUSION: This initial study of the addition of frameless stereotactic systems to the basic intraoperative MRI concept has demonstrated its clinical usefulness. The use of the intraoperative MRI greatly reduces the basic weakness of neuronavigation inaccuracy due to target shift. The surgical procedure performed in the imaging volume of the MRI scanner eliminates the problems of patient or scanner transport during the procedure. Immobilization of the patient throughout the procedure eliminated the need for reregistration of the patient, by taking advantage of the fixed camera system in the bore of the MRI system.

Adult↗

PubMed1993

Integrated imaging system for stereotactic neurosurgery.

Talairach's method remains the most universal of all stereotactic methods. It makes it possible to go back to an examination left interrupted, but above all, it provides multiple lateral and coronal approaches in matters of epilepsy, radio-isotopes or photobiology. The advances achieved in modern imaging methods, notably CT and MRI, and the performance of modern computers have enabled us to devise an integrated imaging system meant to accelerate and make feasible calculations of penetrating trajectories, according to the position of the target as previously defined by CT and MRI sections, and taking into account the position of vessels given by angiography. The principal options we selected were: transfer onto video tapes of teleangiographic films and introduction of CT and MRI images obtained either from films or directly in digits on cartridges or networks. The system includes an advanced PC-type microcomputer with 8 memories of 1,024/1,024 images: 4 mega octets random access memories and a hard disc of 150 mega octets; 2 high-resolution screens to present the images, dialogue tools (alphanumeric screen, keyboard, trackball) and the usual peripherals. Our system performs three main functions: it acquires images to create or complete the patient's records; it exploits the images by calculating the parameters required for operations; it handles the records through the various peripherals of the system. Our system can retrace the proportional 3D squaring according to the CA-CP distance calculated from ventriculography or MRI, and calculates the position of the SEEG electrodes. The stereoscopic effect is obtained by means of glasses with liquid crystal obturator from two angiographic series: one orthogonal, the other 6 degrees out of phase. The daily use of this system on more than 50 patients has shown that it is accurate and reliable, irrespective of the makes of CT and MRI machines.

Brain↗