SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Our first impulse was to pave the cow path, to computerize the way manual procedures were done. Then we tried to straighten out the cow path, to make those procedures more efficient. In this article, contributing editor Jim Wesley says we're still thinking this way, and argues that maybe we shouldn't be following the cow path model at all.
Until the recent past, sterility of an injectable product was only discussed in absolute terms. Any description of sterility other than as an absolute could simply not be envisioned. While dealing in absolute yes/no statements is philosophically satisfying, these yes/no statements can't accommodate all real world scientific problems. Among these problems is the sterility problems faced in the mass production of injectable compounds. Many descriptions of procedures employed to achieve sterility in parenteral production batches were reported in the literature. The theoretical framework that could unite the widespread observations and practices into practical methodology was missing until recently. Production line control of the sterility of injectable products was essentially based on gut evaluations. The present achievement of rational, production line control of product sterility is based on the recognition that product sterility could not be simply regarded as a sharply edged yes/no affair. The present rational control is based on the fact that the sterility of a product is determined by the degree of contamination in the product prior to sterilization and to the parameters of the sterilization process. The end result of the sterilization process is now described as a probabalistic reduction of the initial contamination. The essential laboratory measurements on which this conclusion was based is due to Pflug (1-3). He assembled a theoretical framework, based on experimental data, that characterizes the sterility achieved in an injectable product with a single number. The end result of the sterilization process is now described as a probabalistic reduction of the initial contamination. As in many disciplines, the ability to achieve an objective evaluation of this important attribute provided the basis for scientific analysis, improved control and thus improved production and reduced cost. An equivalent framework is essential for the communication and standardization of the results of a visual inspection for contaminating particles. The control of particle contamination in injectable products is a two-fold problem for the pharmaceutical industry. The two parts of the problem are 1) achieving contamination free product and 2) achieving this contamination free quality at an economic cost acceptable to the user. Today, there is no commonly accepted framework for the definition or analysis of the results of a manual inspection for "visible" particles. Any progress toward global harmonization of the results of a visual particle inspection must commence with the development of a common scientific language with which inspection security and economic effectiveness of an inspection can be discussed and rationally evaluated. The tools with which to define and control the results of this inspection have been developed in biophysics, illumination engineering, optics, pharmaceutical manufacturing and statistics. With them, statistically replicable measures have been developed. The statistically replicable measures are then used to evaluate the results of semi- and fully automated particle inspection systems in terms of human inspection performance. The numerical evaluation of both the freedom from contamination achieved with an inspection for particle contamination and the economic effectiveness of the inspection are compared to Pflug's sterility index. In the case of particle contamination, the final product quality depends on product quality prior to inspection and to the parameters of the inspection process.
AIMS: The aim of this paper is to communicate attributes, antecedents, and consequences identified within the 'continuum of care' using the process of concept development. BACKGROUND: The term 'continuum of care' is embedded in health care experience and is consistently taken for granted in health care literature without adequate analysis or definition. METHODS: Using EndNote and MS Excel software, a sample of 153 articles from 638 nursing and allied health journal articles retrieved by electronic search were reviewed; keywords descriptive of the concept were manually extracted. An electronic library was created and searched for keyword frequencies and words were ranked and sorted into unifying categories. FINDINGS: Four major unifying categories of attributes: people, environment, events and time, were identified, described and encorporated into a definition of the concept. An exemplar case was identified. CONCLUSIONS: The continuum of care was identified as a concept with specific, describable attributes evidenced in an exemplar case.
The computerization of any manual system must be carefully planned before a computer system is selected. An adequate record-keeping system must exist before conversion to a computerized system takes place. Once selected, the computer vendor must be able to provide what the customer requires. More importantly, the computer vendor must be able to provide support services after the system is implemented. User capabilities and acceptance must be considered, and each step of the implementation phase must be thoroughly communicated to all who will be affected. Finally, to provide the most accurate real-time information, files must be maintained and updated as changes occur.
A two-stage general population study of affective disorder and problems of eating control in 15-19-year-old girls is in progress, the sample being identified by the use of general practitioners' age-sex registers. So far, 244 girls and their mothers have been interviewed and have independently completed questionnaires relating to mood and appetite control. The girls completed questionnaires both on themselves and on their mothers, and their mothers on themselves and on their daughters. Significant correlations between self-rating and rating of the other person were obtained in all cases, with agreement on the daughters' mood being higher in non-manual couples.
BACKGROUND: This study aimed to explore the effects of emotionally salient material on thought disorder in patients with bipolar affective disorder. METHOD: Seventy-one participants (20 manic, 15 depressed, 16 currently well patients and 20 non-psychiatric-controls) were interviewed in two conditions: an emotionally salient interview and a non-salient interview. Speech samples were rated using the Scale for the Assessment of Thought, Language and Communication. RESULTS: Manic patients presented with significantly more thought disorder than any other group in both conditions and exhibited the greatest reaction to emotionally salient material. CONCLUSION: The effects of emotional salience on thought, language and communication are not unique to schizophrenic patients. The speech of manic patients is more affectively responsive than the speech of remitted, bipolar depressed and normal participants. The implications of these findings are discussed.
A four-physician group had developed a very successful practice model, but cost accounting was not well-developed as general ledger and accounts payable activities were performed using manual methods and financial statements were prepared on a spreadsheet program. The purpose of this case study is to describe the steps taken to develop a cost management system for the laboratory and the corrective action taken to reduce a loss from operations.
The Nursing Financial Management System, developed by the Department of Nursing Administrative Services (DNAS), depended on a manual data-retrieval and report process to integrate patient acuity, nursing resource, and hospital financial data. Manual processes proved to be extremely labor-intensive and cost inefficient. Approximately 52% of DNAS resources, totaling $45,542 annually, were dedicated to data re-entry functions and report generation. Additionally, time required to produce manual reports created a service gap in that delays caused inefficient management of nursing resources at the unit level. The DNAS used a continuous quality improvement framework to improve data management by automating data retrieval and report generation. Computerization increased department staff productivity with subsequent labor cost savings/avoidance. After computerization, the report process consumed 6% of department labor resources compared with 52% using the manual process. Redistribution of DNAS resources prevented hiring additional staff to manage expanding workload. Finally, timely reporting to unit management resulted in significant reduction in hospital costs, because nursing resource use was matched with patient care demands.
There is no general consensus how to classify and diagnose depressive disorders. The main reason is disagreement regarding etiology. This is reflected in the several theoretical models of depression which has been proposed. On the other hand, a reliable way of characterizing groups of patients that can be used by both clinicians and researchers, is necessary both for communication and progress of research. Facing this situation, the inclusion of etiological theories in classification of depression obviously would be an obstacle to the use of such a classification system by clinicians of various theoretical orientation at current. Thus, a classification system which describes the clinical features of the mental disorders comprehensively and at the lowest order of inference necessary to identify the disorder in a reliable way is needed. The third edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM-III) represents such a classification system. By providing operational diagnostic criteria for each diagnosis, DSM-III represents a major achievement of classification in clinical psychiatry and research. This paper will present the classification of depression and the problem of differential diagnosis as outlined in DSM-III. Further, the validity of the DSM-III classification of depression will be discussed with reference to some recent research findings on biopsychosocial and treatment aspects of depressive disorders.
Surgical pathology specimens are an important resource for medical research, particularly for cancer research. Although research studies would benefit from information derived from the surgical pathology reports, access to this information is limited by use of unstructured free-text in the reports. We have previously described a pipeline-based system for automated annotation of surgical pathology reports with UMLS concepts, which has been used to code over 450,000 surgical pathology reports at our institution. In addition to coding UMLS terms, it annotates values of several key variables, such as TNM stage and cancer grade. The object of this study was to evaluate the potential and limitations of automated extraction of these variables, by measuring the performance of the system against a true gold standard - manually encoded data entered by expert tissue annotators. We categorized and analyzed errors to determine the potential and limitations of information extraction from pathology reports for the purpose of automated biospecimen annotation.
The liver is the primary target organ for hematologic metastasis of colorectal cancer (CRC), and CRC liver metastasis (CRLM) often precludes radical resection, making it the leading cause of death in patients with CRC. To improve the identification and prediction of liver metastasis risk, we identified a cell type of liver metastasis--triggering malignant cells (LMTMCs) through integrating single-cell RNA sequencing and spatial transcriptome analysis. Multiomics cell communication analysis indicated that the interaction between fibroblasts and LMTMCs through the COL1A1-CD44/SDC4 and LAMA4-CD44 signaling axes could promote CRLM. By applying the one-class logistic regression algorithm, we developed a CRLM scoring system in the bulk RNA-sequencing data according to the abundance of LMTMCs in each individual. Using the grouping labels derived from the CRLM scoring system in the bulk data and the corresponding whole-slide images without any manual annotations at the region or pixel level, processed via slide-level weakly supervised learning, a deep-learning model based on the ResNet18 architecture, called Colorectal Liver Metastasis Pathomics Model, was developed to predict the risk of liver metastasis in patients with CRC. The Colorectal Liver Metastasis Pathomics Model achieved an area under the curve of 0.84 at the internal test set of The Cancer Genome Atlas-CRC histology images. In the external independent validation sets, namely the Affiliated Hospital of Southwest Medical University and the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University cohorts, the areas under the curve were 0.89 and 0.72, respectively, indicating effective classification performances. This study provided new insights and tools for the early identification of CRLM and demonstrated the potential of combining multiomics with deep learning-based pathomics in cancer research.
This study presents an analysis of children's spontaneous production of words and gestures during an experimental symbol learning task. Namy & Waxman (1998) previously reported that children aged 1;6 interpreted novel arbitrary words (e.g., blicket) and manual gestures (e.g., a dropping motion) as names for object categories (e.g., fruit) but that at 2;2, children interpreted words as names more readily than gestures. Based on this finding and other observational evidence of gesture use, it has been suggested that the younger infants have an initial general symbolic capacity that encompasses both words and gestures. Over time, as infants acquire greater experience with language, words begin to take on a greater priority in the infant's communicative repertoire. The current study examines this hypothesis by analyzing children's spontaneous production of the novel symbols in Namy & Waxman's original task. At 1;6, children rarely produced either the novel words or gestures. At 2;2, children frequently produced both symbolic forms; however, words were produced in a referential manner while gestures were produced in a non-referential manner. These findings are consistent with the argument that over time, words supplant gestures as a symbolic medium.
BACKGROUND: The symptom of thought broadcast may have diagnostic significance but its definition varies. AIMS: To examine multiple definitions of thought broadcast in different texts, to synthesise their common features and to undertake local and national surveys of psychiatrists to determine which definitions they endorse. METHOD: A semi-structured literature review of electronic databases, supplemented by a manual search of psychiatric textbooks, conceptual analyses and postal surveys of clinicians in North Trent (58 trainees and 70 consultants) and throughout the UK (49 professors of general adult psychiatry). RESULTS: Thought broadcast is susceptible to multiple definitions: three exemplars were identified in the literature, each endorsed by influential authors. Among those psychiatrists responding to the survey (approximately 59%), some endorsed each definition of thought broadcast. CONCLUSIONS: Thought broadcast means different things to different people. Inconsistent terminology might impair communication in clinical and research contexts.
The traditional order and delivery activities have been characterized by manual routines and a paper-based workflow management. Problems such as the time consuming processes in which a laboratory service order is created or that of getting the laboratory service report with results from the requested investigations from the laboratories and the entry of the same information by different persons at different points in the workflow with the possibilities of transfer errors are well known. The development of modern information technology, along with the developing of standards for communication protocols and the message structure for the electronic interchange of information (EDI) gives us the tools to change the way we work and manage workflow. An important input to the business process reengineering process is a thorough knowledge of the context within which the order-/delivery activities exist. One has to take into account that the activities are: 1) heavily integrated in the whole treatment and care process, 2) together with routines and the taking of samples and related requests many times are a part of the daily work of a ward, and 3) many decisions about the treatment of a patient are based on the results in the laboratory service report from the laboratories.
BACKGROUND: Pneumothorax is a potentially dangerous condition which may arise unexpectedly during anaesthesia. The diagnosis is one of exclusion, as initial changes in vital signs (cardiorespiratory decompensation and difficulty with ventilation) are non-specific, and other causes of such changes are more common, whereas local signs may be difficult to elicit, especially without full access to the chest. OBJECTIVES: To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for pneumothorax, in the management of pneumothorax occurring in association with anaesthesia. METHODS: Reports of pneumothorax were extracted and studied from the first 4000 incidents reported to the Australian Incident Monitoring Study (AIMS). The potential performance of the structured approach, using the combination of algorithims described above for each of the relevant incidents, was compared with the actual management as reported by the anaesthetists involved. RESULTS: Pneumothorax was noted as a possible diagnosis in 65 reports; 24 cases had a confirmed pneumothorax, of which 17 were in association with general anaesthesia. It was considered that, correctly applied, the application of the algorithms would have led to earlier recognition of the problem and/or better management in 12% of cases. CONCLUSION: Any pneumothorax may become a dangerous tension pneumothorax with the application of positive pressure ventilation. Limited access to the chest during anaesthesia may compromise the diagnosis. Recognition of any preoperative predisposition to a pneumothorax (for example, iatrogenic or traumatic penetrating procedures around the base of the neck) and close communication with the surgeon are important. Aspiration diagnosis in suspected cases and correct insertion of a chest drain are essential for the safe conduct of anaesthesia and surgery.
Radionuclide ventriculography permits nongeometric calculation of ventricular volume. Accurate and reproducible determination of left-ventricular (LV) blood-pool counts is necessary to perform this calculation. Furthermore, to make serial volume determinations one must know the half-time of in vivo blood-pool activity. We compared five methods of LV count determination in nine patients. Interpatient and intrapatient variability of the in vivo half-time of Tc-99m-labeled red blood cells (RBCs) was measured. Left-ventricular count determinations, derived from temporally and spatially smoothed images using a second-derivative algorithm to identify the LV region of interest (ROI), are less variable than those based on manual ROI determinations. The mean in vivo half-time of Tc-99m RBCs is 4.1 hr, and there is significant interpatient (0.9 +/- 0.8 hr) and intrapatient (1.0 +/- 0.9 hr) variability. These findings should be considered in the determination of serial, relative ventricular volume by radionuclide ventriculography.
Angelman syndrome (AS) is a neurodevelopmental disorder characterized by severe mental retardation, ataxia, and a happy/sociable disposition. Maternally, but not paternally, derived defects, such as duplications, within the AS critical region result in autistic symptomatology, suggesting that the UBE3A gene might be implicated in the causation of autism. This study examined the prevalence of autism in AS in 19 children representing three known molecular classes of AS. Children were studied over the course of 1 year. Forty-two percent of this population, eight of 19 children, met criteria for autism according to the Autism Diagnostic Observation Schedule (ADOS). Parents of children who were diagnosed with autism according to Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria as well as the ADOS - Generic, Module 1 (ADOS-G) were administered the Autism Diagnostic Interview - Revised (ADI-R). Data from the ADI-R were convergent with data from the ADOS-G in all cases. Children with comorbid autism and AS scored lower on measures of language, adaptive behavior, and cognition, and demonstrated a slower rate of improvement over the course of the study. Furthermore, they demonstrated deficits in communication and socialization that mirror those observed in children with idiopathic autism. The study highlights the phenotypic overlap between autism and AS and increases the probability that dysregulation of UBE3A may play a role in the causation of autism.
The authors attempt to show similarities and differences between a spectrum and the DSM-IV perspective in how psychopathology is best represented to clinicians and clinical researchers. Subthreshold symptoms are given little or no attention in DSM; noncriterion symptoms are given none at all. Not otherwise specified disorders may be a widely used category in DSM-IV, but in a spectrum diagnosis there is no similar designation, because use of the whole spectrum of symptoms is possible. Although a DSM-IV categorical disorder may not be the best representation of psychopathology, it is clearly defined and is efficient for the purposes of communication and labeling. Both systems of nosology are essentially atheoretical; comorbidity exists in both, although to a lesser degree in some spectrum models. Data are summarized that clearly demonstrate the need for designers of DSM-V to create a nosology that is, at least in part, dimensional.