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PubMedDate not supplied

Substance abuse with mental disorders: specialized public systems and integrated care.

Separate public financing and regulation of substance (SA) abuse treatment distinct from mental health (MH) treatment preserves a focus on the special needs of those with substance abuse but creates challenges to providing appropriate care for the large number of people with co-occurring conditions. This paper reviews recent efforts to overcome these challenges through clinical and systems approaches that better integrate care. Although much progress has been made for some subgroups of people with co-occurring disorders, further efforts to develop and sustain clinically integrated service delivery approaches within separate systems, particularly in SA treatment settings, are needed.

Cognitive Behavioral Therapy↗
PubMed2004

Influence of ski pole grip on peak upper body power output in cross-country skiers.

This study tested the influence of three ski pole grip systems (pole grip + wrist strap) on peak upper body power output: a traditional system (Swix PC grip and simple strap); a modern system (Swix PC grip and SR94 strap); an integrated system (Yoko 232 grip and Yoko 232 strap). Nine men [mean (SD): 32 (12) years, 177.0 (5.4) cm, 75.1 (6.0) kg] and two women [24 (9) years, 174.6 (3.6) cm, 67.3 (7.7) kg], all of whom were experienced cross-country ski racers at the regional, national, or international level for the U.S., performed three successive upper body power (UBP) tests on a modified double-poling ergometer. Each subject performed three 15-s tests of UBP using stiff cross-country ski poles (classic length; same poles for all tests per subject) and a resistance corresponding to 3% of body mass. Peak UBP was determined as the highest 5-s average power output during the last 10 s of each test. The three grip systems were tested in a counterbalanced order with 3-3.5 min of rest between tests. Peak UBP data were analyzed using a two-factor RM ANOVA and Sheffe's post-hoc test at the 0.05 alpha level. Peak UBP for the integrated system [mean (SE): 169.2 (6.8) W or 2.30 (0.06) W/kg] was significantly higher than value for both the modern [164.1 (7.2) W or 2.23 (0.07) W/kg] and traditional systems [162.5 (7.0) W, or 2.21 (0.06) W/kg] for absolute and relative power output (P<0.05). Given that double-poling peak UBP can be influenced by the ski pole grip system, a skier's choice of grip system may also influence cross-country ski racing performance.

Adult↗
PubMed2003

An integrated microfluidic system for reaction, high-sensitivity detection, and sorting of fluorescent cells and particles.

Presented is a novel approach for an integrated micro total analysis system (microTAS) based on a microfluidic on-chip device that supports ultrasensitive confocal detection of fluorescent cells and particles and subsequently allows for their precise sorting in the fluid phase with respect to spectroscopic properties, such as brightness and color. The hybrid silicone elastomer/glass chip first comprises a branched channel system to initiate fluid mixing and to hydrodynamically focus the sample solution down to a thin flow layer, matching the size of the confocal detection volume placed at that position and, thus, providing a high detection efficiency. In the subsequent on-chip module, the dispersed cells or particles can be sorted into two different output channels. The sorting process is realized by a perpendicular deflection stream that can be switched electrokinetically. The performance of the automated sorting routine is demonstrated by precise partition of a mixture of differently colored fluorescent beads. Moreover, the specifically branched channel geometry allows for direct implementation of reaction steps prior to detection and sorting, which is demonstrated by inducing a selective recognition reaction between the fluorescent protein R-phycoerythrin and a mixture of live bacterial cells exhibiting or lacking the respective surface antigens.

Journal Article↗
PubMed1994

Tying it all together: integrating a hospital-based health care system through case management education.

Recognizing the importance of the case manager as a system integrator, United Health Services, Inc. (UHS), a hospital-based health care system located in upstate New York, implemented several diverse case management models. Case managers were working in a variety of settings, often in isolation. It was determined that a system-wide case management education program would accomplish two goals: (a) provide all case managers within the UHS system with similar case management practice skills and language, and (b) provide an opportunity for case managers to meet, share role responsibilities and common case management issues, and use each other as resources. With input from leadership throughout the UHS system, a 4-week case management education program was developed and presented. Participants included multidisciplinary staff who had case management responsibilities within the system. Sessions were taught by UHS staff experts in a number of different disciplines. A teaching guide and manual were developed to supplement the didactic material. Feedback from the program was provided via written participant evaluation and follow-up discussions.

Health Occupations↗
PubMed2003

Microscale separation and analysis.

There is a recent and growing interest in microscale separation and analysis, a result of advantages of miniaturization such as rapid separation times, high performance and throughput, reduced costs, and the possibility of system integration and multiplexing. Adopting the concepts of conventional capillary electrophoresis, capillary electrochromatography, micellar electrokinetic chromatography and various sample preparation techniques to microchip format, in conjunction with the integration of different analysis steps into a monolithic system, have opened new levels in performance, functionality and throughput. This review summarizes the recent advances in the field of microfabricated separation devices for genomics, proteomics and high-throughput screening applications, also addressing system integration and micropreparative functionalities.

DNA↗
PubMed1996

Formularies in integrated health systems: Sharp HealthCare.

Formulary management implications are described for a California health system consisting of 7 hospitals, 4 skilled-nursing centers, 22 medical clinics, 8 urgent care facilities, and a health maintenance organization. Sharp HealthCare serves nearly 1 million people in the San Diego area. A single institutional care division (ICD) pharmacy service has been created under the guidance of a steering committee consisting of a pharmacy operations coordinator and a staff pharmacist from each site, the system pharmacy director, the system senior pharmacy information systems specialists, and the system senior clinical pharmacy specialist. Operations at each site are overseen by an operations coordinator instead of a pharmacy director. Functional teams reporting to the steering committee are standardizing pharmacy processes, including formulary management; this is particularly important because the ICD has pharmacist and nurse per diem pools. Until 1995, formularies were independently managed at each site. Now, one system formulary is being developed. Standard policies and procedures, a nonformulary drug request form, and a monograph format have been completed. The hospitals' autonomous medical staffs have thus far elected to retain individual pharmacy and therapeutics (P&T) committees but approved a revamped formulary review process and systemwide P&T subcommittees. The computer system is being enhanced so that pharmacists anywhere in one of the hospitals will have access to applicable P&T committee-approved guidelines for drug use. Since vendors were advised that the system is establishing one formulary, Sharp has been able in some cases to achieve better pricing than it previously could through its purchasing group. Drug use is influenced by each site's pharmacy and therapeutics committee. The ideal, however, is to have this responsibility consolidated in a single systemwide committee.

California↗
PubMed1995

Specialty care in integrated networks.

Properly sizing a panel of physician subspecialists is integral to the cost-effectiveness and efficiency of an integrated system. This installment in our series "Building an Integrated Healthcare System" explains how to select, compensate, and organize your subspecialty component.

Credentialing↗
PubMed1997

Evolution of computer-based information systems and networks to support integrated health care delivery systems.

As health care delivery systems become more integrated with an emphasis on community wellness and prevention, well-developed information infrastructures will be needed to support their activities. The article introduces several previously published independent models for the evolution of integrated delivery systems, computer-based patient records (CPRs), and health information networks as well as a summary model that illustrates the relationship among these entities and their somewhat parallel development.

Chronic Disease↗
PubMedDate not supplied

Qualitative models and fuzzy systems: an integrated approach for learning from data.

This paper presents a method for the identification of the dynamics of non-linear systems by learning from data. The key idea which underlies our approach consists of the integration of qualitative modeling techniques with fuzzy logic systems. The resulting hybrid method exploits the a priori structural knowledge on the system to initialize a fuzzy inference procedure which determines, from the available experimental data, a functional approximation of the system dynamics that can be used as a reasonable predictor of the patient's future state. The major advantage which results from such an integrated framework lies in a significant improvement of both efficiency and robustness of identification methods based on fuzzy models which learn an input output relation from data. As a benchmark of our method, we have considered the problem of identifying the response to the insulin therapy from insulin-dependent diabetic patients: the results obtained are presented and discussed in the paper.

Algorithms↗
PubMed1988

The feasibility of a potentially 'ideal' system of integrated diabetes care and education based on a day centre.

A new system of clinical and educational care designed to replace traditional diabetic clinics is described. The overall aims were to provide adequate consultation time, patient access according to diabetic and social needs, minimal waiting time, continuity with experienced staff and objective based learning programmes in an environment suited to learning. This was achieved by changing the role of the diabetes nurse specialist from undertaking delegated tasks to providing primary consultative care, reorganization of existing staff and provision of a purpose designed unit. This gave sufficient flexibility to arrange daily early morning and weekly evening clinic sessions for routine diabetes counselling and medical audit with primary education scheduled at other times. A year's experience showed that our major targets had been met, with the provision of adequate consultation time, halving of waiting time, ease of patient access and continuity with either the doctor or nurse in consulting role. Default rates have fallen and patient and staff morale has improved substantially. Apart from an underestimate of receptionist and a small increase in technician hours, these changes have been achieved within the predicted small revenue cost.

Appointments and Schedules↗
PubMed2004

New hybrid method for reactive systems from integrating molecular orbital or molecular mechanics methods with analytical potential energy surfaces.

A computational approach to calculating potential energy surfaces for reactive systems is presented and tested. This hybrid approach is based on integrated methods where calculations for a small model system are performed by using analytical potential energy surfaces, and for the real system by using molecular orbital or molecular mechanics methods. The method is tested on a hydrogen abstraction reaction by using the variational transition-state theory with multidimensional tunneling corrections. The agreement between the calculated and experimental information depends on the quality of the method chosen for the real system. When the real system is treated by accurate quantum mechanics methods, the rate constants are in excellent agreement with the experimental measurements over a wide temperature range. When the real system is treated by molecular mechanics methods, the results are still good, which is very encouraging since molecular mechanics itself is not at all capable of describing this reactive system. Since no experimental information or additional fits are required to apply this method, it can be used to improve the accuracy of molecular orbital methods or to extend the molecular mechanics method to treat any reactive system with the single constraint of the availability of an analytical potential energy surface that describes the model system.

Journal Article↗
PubMedDate not supplied

Use of operating windows in the assessment of integrated robotic systems for the measurement of bioprocess kinetics.

This study examines the utility of an automated liquid handling robot integrated with a microwell plate reader to enable the rapid acquisition of bioprocess kinetic data. The relationship between the key parameters for liquid handling accuracy and precision and the sample detection period has been characterized for typical low-viscosity (<2.0 mPa x s) aqueous and organic phases and for a high-viscosity aqueous phase (60 mPa x s), all exhibiting Newtonian rheology. The use of a simple graphical method enables the suitability of a given automation platform to be assessed once the user has determined the minimum sample detection period and the minimum accurate and precise dispense volume. This provides for a reduction in the duration of any experiment by maximizing well usage within each microwell plate. The suitability of employing an integrated automation platform to gather kinetic data for systems typical of those encountered in bioprocessing is analyzed via a series of case studies. Application to alkaline cell lysis, where disruption is complete within 120 s, showed that the range of available dispense volumes and the number of wells that can be utilized is limited. In contrast, analysis of a system exhibiting slow process kinetics, the fermentation of Escherichia coli TOP10 pQR239 in microwell plates, demonstrated that, for a typical sample detection period of 30 min, the only restrictions on the degree of well utilization are the liquid handling accuracy and precision and the volume capacity of the liquid handling robot. Finally, liquid-liquid extraction, an example of a kinetically independent operation, was also examined. In this case, only a single equilibrium measurement is required, which means that the only restrictions to the utilization of the integrated devices are the liquid handling accuracy and precision. Integrated automation platforms represent a powerful process development tool over traditional experimental methods used for bioprocess development. Smaller volumes of reagent and sample can be used to achieve greater throughput, while high levels of reproducibility and sensitivity are maintained.

Biotechnology↗
PubMedDate not supplied

Current care of hepatitis C-positive patients by primary care physicians in an integrated delivery system.

BACKGROUND: Infection with the hepatitis C virus (HCV) is an emerging health problem in the United States. Management of this condition in asymptomatic patients remains controversial. METHODS: A questionnaire was mailed in November 1997 to all primary care physicians caring for adults (internists and family physicians) in an integrated health delivery system regarding the current approach to screening, diagnosis, and management of HCV infection. Charts of patients whose tests were positive for HCV were audited in selected practice sites to document care received by those patients. RESULTS: Most physicians (70%) reported ordering alanine aminotransferase (ALT) measurements to screen for HCV infection as part of a complete checkup. Each physician diagnosed an average of 3.1 new cases of HCV infection per year. Patients received widely divergent advice regarding prognosis, precautions to prevent transmission, and treatment. More than one half of the physicians advised their patients that the condition was serious (68%) and to abstain from alcohol (56%) and use condoms in monogamous relationships (62%). In caring for HCV-positive patients, more than three quarters of physicians reported recommending a liver biopsy to patients who had elevated ALT levels, and observing clinically, without liver biopsy, those patients who had normal ALT levels. A chart audit, however, showed less-aggressive intervention. Approximately one third of HCV-positive patients with elevated ALT levels had been seen by a gastroenterologist and had had a liver biopsy. Physicians in practice longer were less likely to recommend treatment with interferon-alpha. Of those patients whose physicians reported they would recommend biopsy and treatment with interferon-alpha, only 36% had a documented liver biopsy in their charts, and 29% had documented interferon-alpha treatment. Only 1.6% and 3.0% of patients, respectively, had received the recommended hepatitis A and hepatitis B vaccines. CONCLUSIONS: Approaches to screening, diagnosis, and management of HCV infection by primary care physicians vary greatly. There appears to be a considerable population of patients in primary care settings who continue to receive conservative management of asymptomatic HCV infection.

Adult↗
PubMed1996

Toward an evaluation of an integrated clinical imaging system: identifying clinical benefits.

Integrated clinical imaging systems can provide the foundation for future computer-based patient record systems as recommended by the Institute of Medicine. However, documenting the benefits of such systems is difficult. This paper reports an evaluation of a clinical imaging system that is integrated with an on-line electronic patient record. The evaluation used interviews and observations to identify what physicians thought were the benefits of this system. Reported benefits may be classified into patient care benefits, educational benefits, and productivity and cost-reduction benefits Physicians said that the imaging system provided patient care benefits by: improving clinical communication and decision making, making care more patient-based, reducing the number of procedures and patient risks, and improving record keeping. Educational benefits they reported included: improving communication, providing broad "real" experience, and improving supervision. These benefits may be reflected in increased productivity and cost reduction by increasing time savings, reducing clerical work, improving morale, and reducing the costs of care. The approach described in this study was valuable in identifying potential benefits of a clinical information system. The findings point the way to realization of benefits for other systems, and, ultimately, for computer-based patient records.

Communication↗