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[Road and home-accident injuries of infants and adolescents in the Lazio region. Results of an integrated surveillance system].

OBJECTIVE: road traffic and home accidents are one of the leading causes of death for infants and adolescents between 0-18 years of age. This study aimed to describe the injuries of children in the Lazio Region, in the year 2000. DESIGN: retrospective cohort study. SETTING: road traffic and home accident injury visits to all Emergency Departments (ED) in the Lazio region during 2000, Hospital discharges in the region during 2000-2001, integrated through deterministic linkage strategy PARTICIPANTS: all children aged 0-18 who visited one of the ED for home or road traffic injuries. MAIN OUTCOME MEASURES: we computed ED visits and hospitalisation rates and stratified them by sex, age and place of residence. Cases were classified by body region and type of lesion. IRR and 95% confidence intervals have been estimated using Poisson Regression. RESULTS: the rate of home accident visits was particularly high among children aged 1-5 years (55.2/1000), while the highest rate for road traffic injuries was in 14-18 year old children (53.8/1000). Girls had a lower hospitalisation rate than boys. Higher hospitalisation rates were found for children living outside of Rome. The body region most frequently injured in road traffic accidents was the lower extremities (28.4%), while most frequently injured in home accidents was the head and neck (34.8%). CONCLUSION: this study shows how integrating different systems of surveillance can provide a more complete picture of injuries from road and home accidents, that is difficult to obtain using other sources. The youngest children are at high risk of home accidents while teen-agers are at risk for road traffic injuries.

Accidents, Home↗
PubMed2001

Integrated microfluidic system enabling protein digestion, peptide separation, and protein identification.

An integrated platform is presented for rapid and sensitive protein identification by on-line protein digestion and analysis of digested proteins using electrospray ionization mass spectrometry or transient capillary isotachophoresis/capillary zone electrophoresis with mass spectrometry detection. A miniaturized membrane reactor is constructed by fabricating the microfluidic channels on a poly(dimethylsiloxane) substrate and coupling the microfluidics to a poly(vinylidene fluoride) porous membrane with the adsorbed trypsin. On the basis of he large surface area-to-volume ratio of porous membrane media, adsorbed trypsin onto the poly(vinylidene fluoride) membrane is employed for achieving ultrahigh catalytic turnover. The extent of protein digestion in a miniaturized membrane reactor can be directly controlled by the residence time of protein analytes inside the trypsin-adsorbed membrane, the reaction temperature, and the protein concentration. The resulting peptide mixtures can either be directly analyzed using electrospray ionization mass spectrometry or further concentrated and resolved by electrophoretic separations prior to the mass spectrometric analysis. This microfluidic system enables rapid identification of proteins in minutes instead of hours, consumes very little sample (nanogram or less), and provides on-line interface with upstream protein separation schemes for the analysis of complex protein mixtures such as cell lysates.

Adsorption↗
PubMed2006

Utilization and drug cost outcomes of a step-therapy edit for generic antidepressants in an HMO in an integrated health system.

OBJECTIVE: Antidepressants do not differ significantly in their ability to treat depression. Excluding the tricyclic antidepressants (TCAs), these drugs also do not differ significantly in their incidence of adverse events. Therefore, the initial choice of antidepressant medication should be based, in part, on cost. The objective of this study was to evaluate the impact on utilization and costs of a generic steptherapy edit for antidepressant drugs excluding TCAs in a health maintenance organization (HMO) in an integrated health system (IHS). METHODS: The pharmacy department of the 440,000-member HMO in an IHS collaborated with the Behavioral Health Clinical Program to design an intervention that required generic antidepressants as first-line pharmacotherapy. Under the GenericStart! Program, a brand-name antidepressant was covered only after trial with a generic antidepressant, excluding TCAs. A step-therapy edit was added to the pharmacy claims processing system on January 1, 2005. All new starts, defined as members with no claims history of antidepressant treatment within the preceding 6 months, were required to use a generic antidepressant. The member copayment was waived for the first prescription. All generic antidepressants were in tier 1 of the drug formulary, with an average copayment of $5 to $10. All brand-name antidepressants were in either tier 2 (preferred brand), with an average copayment of $20 to $25 or 25% coinsurance, or tier 3 (nonformulary brand), with an average copayment of $40 to $45 or 50% coinsurance. Pharmacy claims data from a national pharmacy benefit manager (PBM) without interventions for antidepressants in 2004 or 2005 were used for the comparison group. RESULTS: The generic antidepressant dispensing rate increased by 20 points (32.5% to 52.5%) in the intervention group but only 7.4 points (24.9% to 32.3%) in the comparison group in 2005 compared with 2004. The principal measure of antidepressant drug cost per day of therapy in the intervention group decreased by 11.7% (from $2.40 to $2.12) in 2005 compared with 2004 versus a 2.7% decrease (from $2.60 to $2.53) in the comparison group (P <0.001). Days of antidepressant drug therapy per member per month (PMPM) dropped by 1.5% (from 1.74 to 1.71) in the intervention group versus a decrease of 5.0% (from 1.37 to 1.30) in the comparison group in 2005 compared with 2004. The combination of change in drug cost and utilization resulted in a 13.0% decrease in antidepressant drug cost, from $4.16 PMPM in 2004 to $3.62 in 2005, compared with a 7.6% decrease (from $3.57 to $3.30 PMPM) in the comparison group. The 9.0% difference in drug cost per day represents drug cost savings of approximately $0.36 PMPM or $1,880,562 in 2005 dollars for this HMO of approximately 440,000 members. CONCLUSION: A step-therapy edit requiring HMO members to use a generic antidepressant, excluding tricyclics, prior to use of a brand-name antidepressant resulted in drug cost savings of 9.0% for the entire class of antidepressants, equal to $1,880,562 ($0.36 PMPM) in 2005 dollars in the first year of the intervention. A small (-1.5%) decrease in use of antidepressants occurred in the intervention group, which was less than the 5.0% decrease in utilization of antidepressants in the comparison group.

Antidepressive Agents↗
PubMed1996

Auditory alarms during anesthesia monitoring with an integrated monitoring system.

Alarms in the operating room remain a major source of annoyance and confusion. A previous study by Kestin et al. utilized a specific combination of distinct, separate monitors in 50 pediatric patients. He reported a mean of 10 alarms per case with a mean frequency of one alarm every 4.5 minutes. The alarms were classified as spurious (75%), change outside the alarm limits (22%), or patient risk (3%). We performed a similar study with 50 adult patients under general anesthesia with default alarm settings on an integrated monitor, (Cardiocap, Datex, Helsinki). In our study, the number of alarms averaged 3 per case with a mean frequency of one every 34 minutes. Spurious alarms (those caused by electrocautery, accidental patient movement, or other non-physiological reasons) represented only 24% of all alarms. Those alarms sounding that were outside the limits occurred at a rate of 53%, and those that were considered patient risks occurred at a rate of 23%. Of the alarms, 67% occurred during the beginning and end of anesthesia. The end-tidal carbon dioxide accounted for 42% of the alarms, mostly during intubation and extubation. Suggestions are made for further improvement in alarm systems.

Adult↗
PubMed2001

Compact integrated optical sensor system.

A compact integrated optical sensor system for a large variety of different (bio-) chemical applications using replicated sensor chips is described. Features of the refractometric system to be emphasized for practical applications include a high-resolution window that can be positioned within a wide measuring range, an in situ chip testing and characterization procedure, and on-chip referencing. As an application example, experimental results on refractometric measurements as well as on the suppression of non-specific binding are given.

Biosensing Techniques↗
PubMed2003

CRC Tissue Core Management System (TCMS): integration of basic science and clinical data for translational research.

The Chronic Lymphocytic Leukemia (CLL) Research Consortium (CRC) consists of 9 geographically distributed sites conducting a program of research including both basic science and clinical components. The CRC TCMS was designed to capture and integrate basic science and clinical data sets. The system utilizes multiple data modeling methodologies and web-application platforms, and was designed with the high level objectives of providing an extensible, generalizable model for integrating data as required to conduct translational research.

Biomedical Research↗
PubMed1998

Clinical information systems for integrated healthcare networks.

In the 1990's, a large number of hospitals and medical practices have merged to form integrated healthcare networks (IHN's). The nature of an IHN creates new demands for information management, and also imposes new constraints on information systems for the network. Important tradeoffs must be made between homogeneity and flexibility, central and distributed governance, and access and confidentiality. This paper describes key components of clinical information systems for IHN's, and examines important design decisions that affect the value of such systems.

Computer Communication Networks↗
PubMed2001

The application of a compact multispectral imaging system with integrated excitation source to in vivo monitoring of fluorescence during topical photodynamic therapy of superficial skin cancers.

A novel, compact and low-cost multispectral fluorescence imaging system with an integrated excitation light source is described. Data are presented demonstrating the application of this method to in vivo monitoring of fluorescence before, during and after topical 5-aminolevulinic acid photodynamic therapy of superficial skin cancers. The excitation source comprised a fluorescent tube with the phosphor selected to emit broadband violet light centered at 394 nm. The camera system simultaneously captured spectrally specific images of the fluorescence of the photosensitizer, protoporphyrin IX, the illumination profile and the skin autofluorescence. Real-time processing enabled images to be manipulated to create a composite image of high contrast. The application and validation of this method will allow further detailed studies of the characteristics and time-course of protoporphyrin IX fluorescence, during topical photodynamic therapy in human skin in vivo.

Aminolevulinic Acid↗
PubMed2005

Systems and integrative biology as alternative guises for pharmacology: prime time for an iPharm concept?

Understanding the molecular basis of human disease pathophysiology is critical to accurate disease diagnosis, defining disease progression and to identifying new drugs that more specifically address target diseases. Advances in the understanding of tissue function (including draft maps of the human genome) coupled with industrial-scale, 'enabling' technologies like high throughput screening, combinatorial chemistry, proteomics, etc., have generated data on a scale never before possible. Despite this, there continues to be a dearth of new drug approvals ascribed to: (i) the challenges of working with novel, often non-validated disease targets; (ii) targeting diseases (stroke, Alzheimer's) with limited (if any) treatment and ill-defined clinical trial endpoints; (iii) enhanced regulatory hurdles for drug approval; (iv) insufficient time for the new knowledge and enabling technologies to have reached a productive level. An alternate viewpoint is that unfettered access to such technologies, where exclusion rather than integration has been the hallmark, has markedly reduced the intellectual competent of the biomedical research endeavor, with perceived technological 'quick fixes' displacing the integrative, hierarchical approach of pharmacology, that with medicinal chemistry, represents the core of the drug discovery process. After two decades of profound neglect, pharmacology has re-emerged as the key discipline in providing context to the drug discovery process, facilitating more timely, context-relevant and data-driven outcomes in the search for new drugs. Rather than viewing the future of drug discovery in terms of the 'new' biologies, systems and integrative, a rubric along the lines of iPharm, integrating both established and new technologies, is required.

Animals↗
PubMed2003

Partial characterization of the polluting load of swine wastewater treated with an integrated biodigestion system.

The stabilization of swine wastewaters from swine confined housing by the combination of a upflow anaerobic sludge blanket (UASB) reactor and waste stabilization ponds is a viable alternative to minimize the environmental impact caused by inadequate disposal of swine wastewaters. In the present study, the polluting load of pre-decanted swine wastewater treated with a series of two 0.705 m(3) UASB reactors and then in parallel in aerated and non-aerated stabilization tanks was investigated from January to July, 2000. Physicochemical and microbiological analyses were made adopting standard methods (Standard Methods for Examination of Water and Wastewater, 19th ed., American Public Health Association, Washington, DC, 1995). COD values decreased as the wastewater ran through the integrated biodigestion system dropping from about 3492+/-511-4094 mgl(-1)+/-481 to 124+/-52-490 mgl(-1)+/-230, while nitrate and nitrite levels increased in stabilization tanks, ranging respectively from 4+/-0 to 20 mgl(-1)+/-3 and 3+/-1 to 11 mgl(-1)+/-24. Although the removal of Escherichia coli was more than 97%+/-6, the effluents of the treatment system still contained unacceptable levels of E. coli (1.6 x 10(3)-1.2 x 10(6) 100 ml(-1)) according to WHO guidelines for use of wastewater in agriculture and aquaculture. These results indicate the necessity of changes on operational characteristics of the treatment system such as an increase of the hydraulic retention time in UASB reactors or in stabilization tanks.

Anaerobiosis↗
PubMed1994

System development and integration in healthcare.

Nurse executives are challenged with integrating services within newly formed healthcare systems. The author provides a theoretical framework for system integration. The developmental process of integration in early system development, including the barriers to integration and methods to facilitate the process, are discussed.

Humans↗
PubMed1999

High-resource hospital users in an integrated delivery system.

OBJECTIVES: With decreasing healthcare reimbursement, nurse administrators need to aggressively manage care for high-resource users of hospital services to ensure the viability of their healthcare organization. The objective of this study was to (1) investigate frequent Medicare inpatient admission and emergency department users, (2) investigate Medicare day outliers, and (3) examine Medicare reimbursement/charge ratios. BACKGROUND: Although much research has focused on patients who have been readmitted frequently to the hospital, little research has examined patients who are frequent users of both emergency departments and inpatient services. METHODS: In this study, all 4,920 elderly Medicare inpatient admissions and emergency department visits for 1 year in a 222-bed general hospital were included. Patient profiles of two categories of high resource users were created. RESULTS: Results showed the frequent high user group (n = 75), who had six or more combined emergency department and inpatient admissions per year, had cardiac, diabetic, and chronic respiratory conditions, and came to the hospital from their homes. The day outlier profile (n = 148) consisted of older patients who have neoplasms, and respiratory and circulatory diseases. The mean Medicare reimbursement/charge ratio varied for high volume diagnosis-related groups (DRGS.) IMPLICATIONS: From the study, implications include refining case management, monitoring high-resource patients by computer tracking, analyzing high-user trends by several different methods, incorporating many facets of an integrated healthcare delivery into their care, expanding patient, outpatient, and community support programs, and continually monitoring revenue for organizational viability.

Aged↗
PubMed2003

Manipulators and integrated OR systems - requirements and solutions.

Videoendoscopic (laparoscopic and thoracoscopic) surgery is characterized by challenges for the whole OR team. Additional equipment must be monitored and managed by the surgeon and the nurses in a rather dark environment. The surgeon is using long-shafted instruments that reduce the degrees of freedom of the possible instrument movements, thus limiting the dexterity for the surgeon. The use of trocars results in a pivot point effect when moving the instruments, which needs some experience on the surgeon's side to move the instruments adequately and into the right direction. Finally the hand-eye-coordination is dependent on the camera position relative to the instruments and a stable image of the situs shown at the monitor. To overcome these challenges, several new technologies have been developed and introduced into the OR by the industry, also using robotics to help the surgeon perform the procedure. Integrated OR systems enable the OR team to control virtually all devices in the OR from a centralized panel; scope-positioning systems provide the surgeon with a stable image under his own control and manipulators for the instruments allow fine movements with additional degrees of freedom. This article gives a short overview of currently available technologies, describing the design requirements and the functionality of the different systems.

Journal Article↗
PubMed1998

An integrated multimedia medical information network system.

An integrated multimedia medical information network system at Shimane Medical university has been developed to organize medical information generated from each section and provide information services useful for education, research and clinical practice. The report describes the outline of our system. It is designed to serve as a distributed database for electronic medical records and images. We are developing the MML engine that is to be linked to the world wide web (WWW) network system. To the users, this system will present an integrated multimedia representation of the patient records, providing access to both the image and text-based data required for an effective clinical decision making and medical education.

Academic Medical Centers↗
PubMed2000

Integration of Bombyx mori R2 sequences into the 28S ribosomal RNA genes of Drosophila melanogaster.

R2 non-long-terminal-repeat retrotransposable elements integrate into a precise location in the 28S rRNA genes of arthropods. The purified protein encoded by R2 can cleave the 28S gene target site and use the 3' hydroxyl group generated by this cleavage to prime reverse transcription of its own RNA, a process called target-primed reverse transcription. An integration system is described here in which components from the R2 element of the silkmoth, Bombyx mori, are injected into the preblastoderm embryo of Drosophila melanogaster. Silkmoth R2 sequences were readily detected in the 28S rRNA genes of the surviving adults as well as in the genes of their progeny. The 3' junctions of these insertions were similar to those seen in our in vitro assays, as well as those from endogenous R2 retrotransposition events. The 5' junctions of the insertions originally contained major deletions of both R2 and 28S gene sequences, a problem overcome by the inclusion of upstream 28S gene sequences at the 5' end of the injected RNA. The resulting 5' junctions suggested a recombination event between the cDNA and the upstream target sequences. This in vivo integration system should help determine the mechanism of R2 retrotransposition and be useful as a delivery system to integrate defined DNA sequences into the rRNA genes of organisms.

Animals↗
PubMed2006

SIGMA: a system for integrative genomic microarray analysis of cancer genomes.

BACKGROUND: The prevalence of high resolution profiling of genomes has created a need for the integrative analysis of information generated from multiple methodologies and platforms. Although the majority of data in the public domain are gene expression profiles, and expression analysis software are available, the increase of array CGH studies has enabled integration of high throughput genomic and gene expression datasets. However, tools for direct mining and analysis of array CGH data are limited. Hence, there is a great need for analytical and display software tailored to cross platform integrative analysis of cancer genomes. RESULTS: We have created a user-friendly java application to facilitate sophisticated visualization and analysis such as cross-tumor and cross-platform comparisons. To demonstrate the utility of this software, we assembled array CGH data representing Affymetrix SNP chip, Stanford cDNA arrays and whole genome tiling path array platforms for cross comparison. This cancer genome database contains 267 profiles from commonly used cancer cell lines representing 14 different tissue types. CONCLUSION: In this study we have developed an application for the visualization and analysis of data from high resolution array CGH platforms that can be adapted for analysis of multiple types of high throughput genomic datasets. Furthermore, we invite researchers using array CGH technology to deposit both their raw and processed data, as this will be a continually expanding database of cancer genomes. This publicly available resource, the System for Integrative Genomic Microarray Analysis (SIGMA) of cancer genomes, can be accessed at http://sigma.bccrc.ca.

Adenocarcinoma↗