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PubMedDate not supplied

The micrograph data processing program.

MDPP is a fully featured general-purpose image processing package primarily written to support research in structural biology using data gathered by electron microscopy. It has focused on the analysis of images using Fourier techniques, particularly periodic plane-layer and helical structures, but has extensive tools for other processing options (e.g., point-counting, image quantitation, DNA sequencing, and display). Three-dimensional reconstruction methods are supported, including iterative deconvolution schemes for light micrographs. The basic program is command line-driven, but the user can choose to write sophisticated command scripts and use a menu-driven full-screen or Motif interface to call them. Color images are supported with both color palette and RGB options. Extensive documentation is accessible from within the program as online HELP and also as HTML. Care has been taken to support interfaces to other image processing packages, e.g., MacIntosh applications via the TIFF image format, and other EM-targeted image processing packages. The paper provides an overview of the program, its design, and implementation and outlines future plans for software development. Some general issues concerning image processing program design are discussed.

Computer Simulation↗
PubMedDate not supplied

Effectively managing your reference laboratory relationship.

Clinical laboratories use reference laboratories for laboratory services that they, themselves, routinely are unable to provide, often for economic and/or competency-related reasons. Decisions on reference laboratory providers usually are based upon reputation, quality of service, depth of test menu, other value-added services, testing frequency and turnaround time, price, client services support, information technology support, and logistics. The referring laboratory also is faced with the challenge of how to manage physician ordering patterns and their requests for esoteric testing. This is particularly important and problematic in cases of questionable medical necessity, high cost, or both. This article attempts to address this dilemma and how best to manage the utilization of expensive esoteric tests, particularly in the face of little or no reimbursement for these services by payers and health plans.

Contract Services↗
PubMed1999

The heuristic system. Precision and creativity in addiction treatment.

The Heuristic System (HS) is a method of developing case formulations for use in addiction treatment. Pertinent guidelines, models, or rules of thumb (heuristics) are applied in a stepwise process in order to generate at least two competing or complementary hypotheses concerning the clinical dynamics of the case. These hypothesis are then integrated and/or their relative utility for use in treatment is appraised. Key elements of HS include (a) a model of addiction based on cycles of self-experience, (b) a structured method for arriving at clinical problem formulations, (c) a schematic of the recovery process, (d) a menu of fundamental principles of substance abuse treatment, and (e) a format for providing updatable guidance to the patient for use in treatment. A case developed from the HS approach is presented. This article concludes with a discussion of the implications of HS theory and methods for program design and research.

Comorbidity↗
PubMedDate not supplied

Assessing the quality of health promotion and patient education programs.

Quality assessment for health promotion and patient education programs helps ensure that these services are efficient and effective, and represent professional standards of practice. It also helps ensure that they are beneficial, accessible, and acceptable to members. Three program characteristics should be considered in defining the objectives of an assessment--the degree of existing knowledge regarding the effectiveness of the program, the degree of risk posed by the program, and the cost of the program. A menu of objective is presented, including assessment of the structure of the program; comparison of the program with state-of-the-art models; assessment of program implementation and coverage; measurement of member/patient response; evaluation of program outcome; and evaluation of cost-effectiveness, opportunity costs, and broad benefits to the organization. Major methods for assessment and evaluation are discussed briefly in relationship to the objectives they address--review of professional staff performance; comparison with models, standards, and other criteria; documentation and management information systems; focus groups and other small-scale qualitative methods; participation in plan monitoring and quality assurance activities; and controlled evaluation studies.

Cost-Benefit Analysis↗
PubMed2001

Molecular Biocomputing Suite: a word processor add-in for the analysis and manipulation of nucleic acid and protein sequence data.

In all fields of molecular biology, researchers are increasingly challenged by experiments planned and evaluated on the basis of nucleic acid and protein sequence data generally retrieved from public databases. Despite the wide spectrum of available Web-based software tools for sequence analysis, the routine use of these tools has disadvantages, particularly because of the elaborate and heterogeneous ways of data input, output, and storage. Here we present a Visual Basic-encoded Microsoft Word Add-In, the Molecular BioComputing Suite (MBCS), available at the BioTechniques Software Library (www.BioTechniques.com). The MBCS software aims to manage and expedite a wide range of sequence analyses and manipulations using an integrated text editor environment including menu-guided commands. Its independence of sequence formats enables MBCS to be used as a pivotal application between other software tools for sequence analysis, manipulation, annotation, and editing.

Amino Acid Sequence↗
PubMedDate not supplied

[10 years of nuclear cardiology. (I). Clinical development and technological progress in nuclear medicine at the Ignacio Chávez National Cardiological Institute].

The department of nuclear medicine of the Instituto Nacional de Cardiología started at the right moment (June 2, 1977), when the first cardiological procedures were developed. Unfortunately, it coincided in time with the beginning of the financial crisis. The higher costs of nuclear medicine instruments and operationsdid not allow the evolution of the department according to the original project, as nuclear cardiology demands special tracers and instrumentation, which are expensive and only available abroad. To solve these problems, we planned the creation of our own technology. We created a laboratory for radiopharmacy to elaborate lyophylized ingredients for the "cold" kits for instant labeling with 99Tcm of several tracers. With this, we achieved a substantial decrease in the operating costs, with total independence of commercial firms, and the future of the department was assured. In the field of instrumentation, a new system for tomodensitometric imaging of the thorax has been created by using two external gamma sources 99Tcm, and a digital system for image display and analysis was designed, built and programmed. This system, allowed the development of the quantitative technique of nuclear cardiology. We expect the software menu to be finished within this year. The transit from general nuclear medicine to nuclear cardiology has been slow in this Institute. During the first 8 years, the cardiological studies represented 10.8% of all in vivo studies; this figure increased to 37.8% in 1986. However, the increasing demand of cardiological studies tends to displace other in vivo studies due to oversaturation of the gamma-camera and the digital system. It can be concluded that the evolution of nuclear cardiology has been slow in this Institute, but represents a factual progress based on the creation of a technological substructure with internal resources.

Angiocardiography↗
PubMed2001

A survey of state programs to finance rehabilitation and community services for individuals with brain injury.

This article will review and compare existing state-funded programs and their approaches to financing, administering, and delivering an array of services, including rehabilitation and home and community-based services and supports to individuals with traumatic brain injury (TBI) and their families. A state-by-state chart provides funding and operational characteristics of the programs. The state menu of services provided and how they are delivered are also described. The article addresses how these programs fit within their overall state service delivery system, trends and changes that programs may be undergoing, and the influences that shape these programs.

Brain Injuries↗
PubMed1996

Contraceptive implants: long acting and provider dependent contraception raises concerns about freedom of choice.

David Bromham's editorial on contraceptive implants ignores the wider issues to voice concern that trial by media could limit contraceptive choice by jeopardising research into new methods. However, it is more beneficial to the public for points of conflict to be debated openly. Furthermore, the impetus for research into new contraceptive technology is driven by profit and political motives and is only marginally affected by the media. Implanted contraceptives may increase the choice of contraceptive methods, but they put control of fertility increasingly into the hands of the medical profession. Herein lies their greatest problem: their potential to increase providers' control over clients' choice. There is the danger that certain groups of women may be targeted for their use: in the United States the coercive use of Norplant for mothers receiving welfare benefit has been suggested. Long acting contraceptives are a contraceptive of choice only when they are available without pressure, as part of a wider menu; when instant removal on request is guaranteed; and when there is an open and free flow of information and opinions between users, health professionals, and special interest groups.

Biomedical Research↗
PubMed1990

An assessment of a film enhancement system for use in a radiation therapy department.

The clinical uses of a radiotherapy film enhancement system are explored. The primary functions of the system are to improve the quality of poorly exposed simulator and portal films, and to perform comparisons between the two films to determine whether patient or block positioning errors are present. Other features include: the production of inexpensive, high quality hardcopy images of simulation films and initial portal films for chart documentation, the capacity to overlay lateral simulation films with sagittal MRI films to aid in field design, and a mode to zoom in on individual CT or MRI images and enlarge them for video display during chart rounds or instructional sessions. This commercially available system is comprised of a microcomputer, frame grabber, CCD camera with zoom lens, and a high-resolution thermal printer. The user-friendly software is menu driven and utilizes both keyboard and track ball to perform its functions. At the heart of the software is a very fast Adaptive Histogram Equalization (AHE) routine, which enhances and improves the readability of most portal films. The system has been evaluated for several disease sites, and its advantages and limitations will be presented.

Humans↗
PubMed1998

The British Paediatric Surveillance Unit--a pioneering method for investigating the less common disorders of childhood. Report of a seminar held in June 1995.

The British Paediatric Surveillance Unit (BPSU) of the Royal College of Paediatrics and Child Health is an 'active' case reporting scheme set up in 1986 to facilitate the investigation of uncommon childhood conditions of public health and clinical importance in the UK and Ireland. Its methodology involves the monthly mailing of a card containing a menu of up to 12 reportable conditions to all clinically active paediatricians in the British Isles. Respondents either indicate any cases seen in the past month or make a nil return. The BPSU forwards details of respondents reporting cases to the investigators, who when obtain information from the clinician. The menu changes from time to time and studies undergo a rigorous selection process. In 1995, the BPSU held an international seminar to review lessons learned during its first decade which would improve and develop surveillance of paediatric disorders. Over the 9 years to mid-1995 a total of 34 studies took place (25 completed, nine still in progress) with a high respondent response rate (e.g. 90% in 1994). Underascertainment had been addressed by seeking, in parallel, other sources of cases, e.g. death registrations, laboratory reports, other relevant clinical specialists, and by use of capture-recapture techniques. Other specialties and countries have since followed the BPSU example providing opportunity for multispeciality and international studies. The latter were valuable, but required careful planning to standardize case definitions and laboratory techniques, otherwise geographical differences in the incidence of study disorders were difficult to interpret. The BPSU has facilitated studies which increased knowledge about a range of disorders and informed national policy decisions. It also increased diagnostic awareness and showed itself able to respond to public health emergencies. Its emulation in further countries will have similar benefits.

Adolescent↗
PubMed1993

CDC WONDER: a comprehensive on-line public health information system of the Centers for Disease Control and Prevention.

OBJECTIVES: CDC WONDER, a comprehensive on-line public health information system of the Centers for Disease Control and Prevention (CDC), was developed to place timely, action-oriented information in the hands of public health professionals. METHODS: A unified system was developed de novo to be used for and to evolve along with public health. All data are stored and updated on the CDC mainframe. RESULTS: CDC WONDER provides menu-driven access to 24 databases with information on mortality, hospital discharges, cancer incidence, notifiable diseases, acquired immunodeficiency syndrome, the Morbidity and Mortality Weekly Report, etc.; each database has on-line documentation. Results can be tabulated and graphed, and there is full-text searching of textual databases. Non-CDC staff have access via telephone connection. From August 1991 through June 1992, system databases were accessed 10,698 times, and there were 842 users (mean of 97 new users per month). CONCLUSIONS: CDC WONDER has shown that it is possible to build a large, on-line database of scientific data for public health professionals. CDC WONDER provides a common foundation from which to build information-based public health plans and policy and could help strengthen the public health system.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Postoperative pain guidelines.

BACKGROUND AND OBJECTIVES: Postoperative pain is the expected but nonetheless undesirable byproduct of all surgical procedures. Humanitarian concerns and recent quasi-governmental regulations have heightened awareness about the importance of treating postoperative pain. This guideline builds upon the foundation created by the Agency for Health Care Policy and Research guideline published in 1993, highlights changes that have occurred over the past 10 years, and makes recommendations based on the current scientific evidence. In addition, it takes advantage of the versatile information management inherent in a web-based format to make the information readily available. METHODS: A multidisciplinary group of physicians, dentists, nurses, pharmacists, physical therapists, psychologists, and ethicists from the Veterans Health Administration (VHA) and Department of Defense (DoD) in conjunction with the VHA Office of Quality and Performance and a consultant group developed a postoperative pain algorithm and supporting documentation. The guideline structure and content were determined by a standardized rating of the evidence gleaned from comprehensive electronic searches. RESULTS: An interactive electronic and traditional "paper" guideline with a pre- and postoperative algorithm was developed. A table, which provides a menu of analgesic choices organized by specific operation, was constructed. Preferences for particular analgesic techniques and classes of medications were identified. A postoperative pain interactive pharmacopoeia and printable patient educational materials were also provided. The guideline may be reviewed at the following website: www.oqp.med.va.gov/cpg/cpg.htm. CONCLUSIONS: This postoperative pain guideline provides readily accessible information and evidence-based guidance to a variety of providers. It highlights deficiencies in our understanding of the pain and recovery processes and how they might guide our choices of postoperative analgesic techniques. In combination with the powerful system-wide data collection capabilities of the VHA, there may be improved understanding of what techniques are useful. Finally, it may lead to the development of reliable, individualized analgesic plans for specific surgical procedures that incorporate the full range of pharmacologic and nonpharmacologic techniques.

Algorithms↗
PubMedDate not supplied

Winning the talent war for women. Sometimes it takes a revolution.

In 1991, Deloitte & Touche got a wake-up call about its efforts to retain women professionals. While it was recruiting almost as many women as men, the company had a much higher turnover rate for women. Many in the firm thought Deloitte was doing everything it could to retain talented women, but when they looked harder, they found otherwise. Most women weren't leaving to raise families; they were leaving after having weighed their unpromising career options in Deloitte's male-dominated culture. CEO Mike Cook led the way in making a business case--not a moral or emotional one--for change. Next, the company held mandatory, two-day, intensive workshops for its 5,000 U.S. managers. Case vignettes and discussions brought out subtle gender-based assumptions about careers and aspirations that had discouraged high-performing women from staying. The workshops were instrumental in convincing a critical mass of partners to join the effort, and the firm began to monitor the progress of women to ensure they received their share of mentoring and premier assignments. Executive compensation became linked to how successfully units implemented a flexible menu of goals. And other policies promoted a better balance between work and life for both men and women. Finally, an external advisory council kept the firm's feet to the fire. Deloitte's gender gap in turnover has now nearly vanished, and the number of women partners and directors is the highest among the Big Five. These cultural changes weren't easy, but they've enabled Deloitte to grow faster than any of its competitors.

Accounting↗
PubMed2001

Education on rational nutrition of elementary school children in the city of Lublin.

The paper presents the stages of preparation of Nursing Faculty students of the Medical University in Lublin for realisation of lessons popularising the knowledge about rational nutrition. The analysis of school documents allowed for selecting a group of children aged 11-13. The subjects of the lessons were adapted to the age and demands of the audience. The realisation of the syllabus was made during four meetings in three schools in Lublin. The realisation of dietary education confirmed poor knowledge of nutrition, too little amount of fruit, vegetables and dairy products in everyday menu with big amounts of carbohydrates and animal fat, frequent lack of second breakfast at school. The school, besides the family, should realise the tasks connected with the popularisation of healthy diet and the deficit and excess of body weight). The evaluation of students' educational activities indicated that more time should be devoted to the methodology of health education with particular attention to activating methods within such subjects as public health, family medicine.

Adolescent↗
PubMed1995

An Internet health care information resources server as a component of a statewide medical information network.

A health care information server utilizing Internet resource discovery technology is presented as a component of a statewide medical information network. The development of an information server, including the development process and its design and operation, is presented. Menu design and implementation, which involved providing access to information resources in support of the tasks that make up the health care delivery process, are described. The potential impact of this technology on the health care delivery process is explored, and ways in which access to information can be facilitated and matched with the information needs of the various health care delivery tasks are identified. Issues associated with the use of public domain information resources are discussed, including control over Internet resources, access to information resources, network operational delays, client connection and software availability, information quality, and menu navigation. This project has demonstrated that Internet information resources exist that match the information needs of the tasks that make up the health care delivery process. Positive response has been received from physicians after initial utilization of the server in a stand-alone context. In the future, more applications will integrate the vast information resources on the Internet with traditional computing systems.

Alabama↗
PubMed1995

Current trends with natural language processing.

Natural Language Processing in the medical domain becomes more and more powerful, efficient, and ready to be used in daily practice. The needs for such tools are enormous in the medical field, due to the vast amount of written texts for medical records. In the authors' point of view, the Electronic Patient Record (EPR) is achieved neither with Information Systems of all kinds nor with commercially available word processing systems. Natural Language Processing (NLP) is one dimension of the EPR, as well as Image Processing and Decision Support Systems. Analysis of medical texts to facilitate indexing and retrieval is well known. The need for a generation tool is to produce progress notes from menu driven systems. The computer systems of tomorrow cannot miss any single dimension. Since 1988, we've been developing an NLP system; it is supported by the European program AIM (Advanced Informatics in Medicine) within the GALEN and HELIOS consortium and the CERS (Commission d'Encouragement á la Recherche Scientifique) in Switzerland. The main directions of development are: a medical language analyzer, a language generator, a query processor, and dictionary building tools to support the Medical Linguistic Knowledge Base (MLKB). The knowledge representation schema is essentially based on Sowa's conceptual graphs, and the MLKB is multilingual from its design phase; it currently incorporates the English and the French languages; it will also continue using German. The goal of this demonstration is to provide evidence of what exists today, what will be soon available, and what is planned for the long term. Complete sentences will be processed in real time, and the browsing capabilities of the MLKB will be exercised. In particular, the following features will be presented: Analysis of complete sentences with verbs and relatives, as extracted from clinical narratives, with special attention to the method of "proximity processing" as developed in our group and the rule based approach to language description to resolve the specific surface language problems as well as the language independent semantic situations. Comparison of results for English, French, and German sentences, showing the commonalities between these languages and, therefore, the re-usable features and the language specific aspects. Generation of noun phrases in English and French, showing the opportunities for translation between these two languages. Application of the analyzer to build a knowledge representation of ICD under the form of conceptual graphs and presentation of the possibilities of a natural language encoding of diagnosis. Strategies for query processing through a sample of abdominal ultrasonography reports, which have been analyzed and stored under the form of conceptual graphs. Feeding in and browsing of the Medical Linguistic Knowledge Base and other Dictionary Building Tools, using the perspective of an international initiative to converge towards a multilingual universal solution, valid for the medical domain. The demonstration platform is Microsoft Windows 4 on a PC, with Microsoft Visual Basic as the GUI and Quintus Prolog as NLP tools language. The same programs were originally developed for Unix-based workstations and are available on multiple platforms under Motif and X11. .

European Union↗
PubMed2006

Clinical and education workload measurements using personal digital assistant-based software.

OBJECTIVE: There are no accepted and practical measures of the relative clinical and educational activities of pediatricians who work in an academic health science center. Such measures are necessary for justification of existing and future human resource plans and evaluation of the activities and performance of physicians. The limited literature on the measurement of physician workload usually focuses on a specific subspecialty group and does not account for such issues as indirect patient care, such as telephone calls or e-mail consultations; variables that affect the delivery of clinical care, including patient acuity and complexity; and the presence of students during the patient care activities. After completing a pilot study that assessed the educational workload of faculty members, we adapted existing personal digital assistant technology and software to document clinical and educational activities. METHODS: Twenty full-time physicians from 4 subspecialty pediatric divisions participated in a 2-week evaluation project in May through June 2005. Clinical activities, with and without trainees, and educational activities were collected with the use of personal digital assistants. Software allowed an individualized division-specific drop-down menu. Information that was collected included clinical (location of activity, diagnosis, and time requirement) and educational activities. After completion of a 2-week data collection period, each physician was asked to complete a 5-question evaluation form. RESULTS: The project was completed successfully with capture of additional clinical and educational activities. A 5-question evaluation form was completed by 70% of the participants at the end of the 2-week data collection. Data on clinical and educational activities were analyzed qualitatively and graphed. CONCLUSIONS: This method of workload data collection added significant information in capturing activities that are not measured in traditional workload evaluations for either clinical activities, such as e-mail, telephone, and patient information review, or educational endeavors, including mentoring and educational lectures and presentations.

Academic Medical Centers↗
PubMedDate not supplied

Quantifying the disease impact of alcohol with ARDI software.

Alcohol-Related Disease Impact (ARDI) Software has been developed for the Centers for Disease Control (CDC) to allow States to calculate mortality, years of potential life lost (YPLL), direct health-care costs, indirect morbidity and mortality costs, and nonhealth-sector costs associated with alcohol use and misuse. The mortality related measures--mortality, YPLL, and indirect mortality costs--are computed for 35 diagnoses related to alcohol use and misuse. A review of clinical research studies and injury surveillance studies was conducted to produce estimates of the alcohol-attributable fraction (AAF) for each diagnosis. For these measures, age-specific and age-adjusted rates are also calculated. Health care costs, morbidity costs, and nonhealth-sector costs are prorated from national studies to the State or locality. This multiple-measure approach to quantifying a health problem is termed "disease impact estimation." National estimates of the disease impact of alcohol use and misuse have been produced using ARDI software and State-specific estimates are in preparation. Designed to CDC specifications, ARDI is completely menu-driven and operates within Lotus 1-2-3 software as a set of linked spreadsheets. ARDI adapts national epidemiologic and health economics methods for use by State and local health agencies. ARDI produces data on the health consequences of alcohol use and misuse for use by locally based policymakers, public health professionals, and researchers, while permitting comparison and compilation of these data across jurisdictions.

Alcohol Drinking↗