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At least 1,189 records · Page 66Linked to original sources
PubMed1999

A quality roadmap of a restructured hospital.

This paper presents a quality roadmap of a restructured hospital. Specifically, a case study is showcased to reveal how a FOCUS-PDCA model is applied to the Central Portering Services (CPS) within a restructured hospital, to provide better service to other departments within the hospital who can then in turn value add to the patient care delivery chain. The preliminary results suggest that implementers of quality and service improvement programmes using the FOCUS-PDCA approach should note some of the key implementation difficulties. These difficulties occur at all levels and include issues relevant to change management, process improvement programmes, accessibility to data, communication and judicious execution of the change process.

Hospital Restructuring↗
PubMed2006

Pathway-specific differences between tumor cell lines and normal and tumor tissue cells.

BACKGROUND: Cell lines are used in experimental investigation of cancer but their capacity to represent tumor cells has yet to be quantified. The aim of the study was to identify significant alterations in pathway usage in cell lines in comparison with normal and tumor tissue. METHODS: This study utilized a pathway-specific enrichment analysis of publicly accessible microarray data and quantified the gene expression differences between cell lines, tumor, and normal tissue cells for six different tissue types. KEGG pathways that are significantly different between cell lines and tumors, cell lines and normal tissues and tumor and normal tissue were identified through enrichment tests on gene lists obtained using Significance Analysis of Microarrays (SAM). RESULTS: Cellular pathways that were significantly upregulated in cell lines compared to tumor cells and normal cells of the same tissue type included ATP synthesis, cell communication, cell cycle, oxidative phosphorylation, purine, pyrimidine and pyruvate metabolism, and proteasome. Results on metabolic pathways suggested an increase in the velocity nucleotide metabolism and RNA production. Pathways that were downregulated in cell lines compared to tumor and normal tissue included cell communication, cell adhesion molecules (CAMs), and ECM-receptor interaction. Only a fraction of the significantly altered genes in tumor-to-normal comparison had similar expressions in cancer cell lines and tumor cells. These genes were tissue-specific and were distributed sparsely among multiple pathways. CONCLUSION: Significantly altered genes in tumors compared to normal tissue were largely tissue specific. Among these genes downregulation was a major trend. In contrast, cell lines contained large sets of significantly upregulated genes that were common to multiple tissue types. Pathway upregulation in cell lines was most pronounced over metabolic pathways including cell nucleotide metabolism and oxidative phosphorylation. Signaling pathways involved in adhesion and communication of cultured cancer cells were downregulated. The three way pathways comparison presented in this study brings light into the differences in the use of cellular pathways by tumor cells and cancer cell lines.

Biosynthetic Pathways↗
PubMed2026

Single-cell RNA sequencing reveals disease associated changes in brain endothelial cells in the 5XFAD mouse.

Vascular dysfunction is a key contributor to Alzheimer’s disease (AD) pathology, where changes to the endothelium and its crucial role in maintaining blood-brain barrier (BBB) integrity have been of particular emphasis. The transgenic 5XFAD (5X Familial Alzheimer’s Disease) mouse model, which exhibits AD-related amyloidosis through FAD associated mutations in amyloid precursor protein (APP) and presenilin-1 (PS1), has become a widely adopted preclinical model in AD-related research studies. The need for cross-study standardization, accessibility, and data reproducibility has led to the widespread implementation of the C57BL/6J genetic background for maintaining this model. However, its reliability for studying vascular dysfunction and BBB alterations has been questioned due to conflicting reports in the literature. This variation is often attributed to the previously documented protective nature of the C57BL/6J background and loss of genetic background diversity. Since prior studies have mostly relied on imaging or functional assays, we herein utilized single-cell RNA sequencing (scRNAseq) to investigate AD-related molecular changes to endothelial cell populations in the 5XFAD mouse model. To initially build this resource, we focused on 12-month-old male mice, which revealed differentially expressed genes between 5XFAD and wildtype animals that mapped to signaling pathways involved in DNA damage, immune reactivity, and inflammation, among others. Many of these transcriptomic changes were zonated along the arteriovenous axis and occurred in AD genome-wide association study (GWAS) risk-associated genes. Overall, we anticipate this resource will help clarify the use of the 5XFAD model for studying AD-associated vascular changes and provide the foundation for expanded molecular profiling of brain endothelial cells under AD-associated conditions.

Animals↗
PubMed2005

Recommendations for conducting successful research with Native Americans.

BACKGROUND: In this article, I discuss factors that may affect working relationships between non-Indian researchers and Native American individuals and communities and give recommendations for conducting successful research. METHODS: I describe 7 factors including Native American communities must receive information back from researchers and have access to data collected from them, researchers must address assets and broader social issues, and researchers must place the needs of the community ahead of their own interests. RESULTS AND CONCLUSIONS: Carrying through on the recommendations will make for more effective, culturally appropriate research.

Biomedical Research↗
PubMed2006

Dexmedetomidine for pediatric sedation for computed tomography imaging studies.

Dexmedetomidine is a sedative with limited experience in the pediatric population. This is the first study that prospectively evaluates the sedation profile of a dexmedetomidine pilot program for pediatric sedation for radiological imaging studies. In March 2005, our hospital sedation committee approved the replacement of IV pentobarbital with dexmedetomidine as the standard of care for CT imaging. Detailed Quality Assurance (QA) data sheets collect relevant information on each patient, which is then logged into a computerized sedation database. After IRB approval, all QA data was accessed. Sixty-two patients with a mean age of 2.8 years (SD = 1.8, range 0.5-9.7) received IV (IV) dexmedetomidine administered as a 2 mcg/kg loading dose over 10 minutes, followed by repeat boluses of 2 mcg/kg over 10 minutes until target of Ramsay Sedation Score 4 (RSS) achieved. Patients were then maintained on 1 mcg/kg/hr infusion until imaging is completed. Repeated-measures ANOVA indicated that compared to pre-sedation values, the heart rate and mean arterial blood pressure decreased an average of 15% during bolus, infusion and recovery (P < 0.01). No significant changes were observed in respiratory rate or end-tidal CO2. Mean recovery time was 32 +/- 18 minutes. Based on our pilot results, dexmedetomidine may provide a reliable and effective method of providing sedation.

Child↗
PubMed2006

Survey of prioritizing/triaging of appointments in genitourinary medicine clinics in the UK: a British Co-operative Clinical Group survey.

A questionnaire was circulated to all lead genitourinary (GU) medicine physicians in the UK in November 2003 to obtain data on access, waiting times and triaging. Of the 143 responders, 92.3% departments had limited access to some or all GU medicine clinics. Where access was limited, 5.3% had no identifiable process in place to see urgent patients. The mean waiting times in clinics with an open appointment system only for a routine female and male appointment were 2.9 weeks and 2.8 weeks (range 2 days-10 weeks), respectively, and for an urgent appointment, two days (range same day-14 days), for both sexes. The survey has raised concerns that a number of departments did not consider as urgent for prioritizing, patients with documented untreated gonorrhoea, syphilis, or HIV, or contacts of patients with these conditions. This survey has highlighted a need for the national specialist society to provide guidance on prioritizing patients where access is limited.

Ambulatory Care Facilities↗
PubMed2002

[The prevalence of childhood sexual abuse, physical abuse and emotional neglect in Europe].

This paper concentrates on the prevalence of childhood sexual abuse, physical abuse and emotional neglect in Europe. It includes studies published in international journals or in easily accessible books. Data bases, specifically MEDLINE, PubMed, Psyndex and PsycInfo were used to find papers on this topic. Taking a broad view there is an incidence of sexual abuse experiences of 6-36 % in girls under the age of 16 years and of 1-15 % in boys under the age of 16. The incidence of physical abuse ranges from 5 to 50 % in Europe. There is a need for studies dealing with the prevalence of emotional neglect or psychological abuse. These figures are in line with those found in North America. However, due to the large differences in definitions and data gathering techniques, more precise conclusions are currently not possible.

Adolescent↗
PubMedDate not supplied

When insurance status is not static: insurance transitions of low-income children and implications for health and health care.

OBJECTIVES: Among low-income children, to characterize the frequency of transitions in health insurance coverage and examine associations of transitions with health status and health care access. METHODS: Data from the 1999 National Survey of America's Families were used in weighted analyses to identify sociodemographic characteristics associated with health insurance transitions for children living in households with income <200% of the federal poverty level over the preceding 12 months. In logistic regression models, we examined associations of insurance transitions with children's health status (fair/poor health), postponement of children's medical care or prescription medications, and lack of physician visits. RESULTS: Among 27.93 million low-income children in 1999, 5.7 million (20.4%) had experienced an insurance transition in the preceding year. Non-Hispanic black children (24.5%) and children whose parents did not have a partner or spouse (23.5%) were significantly more likely than other children to have experienced transitions. Hispanic children (16%) were least likely to have experienced transitions. Compared with children with continuous private coverage, children who had transitioned from public to private coverage were more likely to report fair or poor health, children who experienced transitions that included a period of no coverage were more likely to report postponed medical care and prescription drugs, and children who experienced a no-coverage-to-private-coverage transition were more likely to have foregone physician visits. CONCLUSION: Transitions in insurance coverage affect many low-income children and may represent barriers to their health care. Considering insurance transitions may provide a more complete picture of children's health and health care utilization.

Child↗
PubMed2000

Computer decision support systems.

Computer decision support systems are computer applications designed to aid clinicians in making diagnostic and therapeutic decisions in patient care. They can simplify access to data needed to make decisions, provide reminders and prompts at the time of a patient encounter, assist in establishing a diagnosis and in entering appropriate orders, and alert clinicians when new patterns in patient data are recognized. Decision support systems that present patient-specific recommendations in a form that can save clinicians time have been shown to be highly effective, sustainable tools for changing clinician behavior. Designing and implementing such systems is challenging because of the computing infrastructure required, the need for patient data in a machine-processible form, and the changes to existing workflow that may result. Despite these difficulties, there is substantial evidence from trials in a wide range of clinical settings that computer decision support systems help clinicians do a better job caring for patients. As computer-based records and order-entry systems become more common, automated decision support systems will be used more broadly.

Computer Systems↗
PubMed2005

Clinical and radiological follow-up of laparoscopic adjustable gastric bands, 1998 and 2000: a comparison of two techniques.

BACKGROUND: Concerns still exist about the long-term effectiveness and rate of retention of the laparoscopic adjustable gastric band (LAGB). Furthermore, esophageal dilatation has been suggested as a long-term complication for LAGB. We therefore sought to objectively analyze our follow-up results in patients with LAGB performed in 1998 by perigastric technique and 2000 by pars flaccida technique. We also offered patients for 1998 a barium esophagram to assess dilatation. METHODS: Data on all 2,300 LAGBs performed since 1996 have been prospectively collected in LapBase. This data was accessed for 1998 and 2000, for follow-up complication, band removal, weight loss and comorbidity reduction. Patients were offered barium esophagrams. RESULTS: 123 patients (mean weight 127 kg, mean BMI 44.5 kg/m2) had LAGB in 1998, and 162 patients (mean weight 123 kg, mean BMI 44) had LAGB in 2000. Follow-up was a mean 67 months in 88% for 1998 and 94% at 34 months for 2000. Mean %EWL for 1998 was 51.2% with mean BMI 31.9. Slippage occurred in 9.5% in 1998 compared to 4.3% in 2000 (P<0.01). 20 of 23 diabetics are off all treatment. 1 of 34 patients had esophageal dilatation on barium esophagram, which resolved on band deflation. CONCLUSION: LAGB is a safe and effective at midterm follow-up. Less slippage occurred after the pars flaccida technique. No evidence of permanent esophageal dilatation was found on barium studies.

Adolescent↗
PubMed2006

Does crew resource management training work? An update, an extension, and some critical needs.

OBJECTIVE: This review provides the state of crew resource management (CRM) training evaluations since the E. Salas, C. S. Burke, C. A. Bowers, and K. A. Wilson (2001) review and extends it to areas beyond aviation cockpits. Some critical evaluation needs in CRM training are also covered. BACKGROUND: Because of the purported success of CRM training in aviation, other high-consequence domains have begun to implement CRM training for their workforces. However, the true impact of CRM training in aviation and these other domains has yet to be determined. METHOD: Using D. L. Kirkpatrick's (1976) framework for evaluating training (i.e., reactions, learning, behavior, and organizational impact), we reviewed 28 published accounts of CRM training to determine its effectiveness within aviation, medicine, offshore oil production and maintenance, shipping/maritime, and nuclear power domains. RESULTS: Findings indicate that CRM training generally produced positive reactions from trainees; however, the impact of training on learning and behavioral changes suggest mixed results across and within domains. Furthermore, and as was found by Salas, Burke, et al. in 2001, we cannot ascertain whether CRM has had an impact on the organization's bottom line (i.e., safety). CONCLUSION: Based on the results, there are several critical needs that the CRM training community must address before CRM training can have the desired impact on safety: a mandate, access to data, and resources. APPLICATION: As CRM training expands to organizations beyond aviation, it is critical that its impact be understood such that it can be improved and achieve the intended results.

Fatigue↗
PubMed2005

Reproducible research: a bioinformatics case study.

While scientific research and the methodologies involved have gone through substantial technological evolution the technology involved in the publication of the results of these endeavors has remained relatively stagnant. Publication is largely done in the same manner today as it was fifty years ago. Many journals have adopted electronic formats, however, their orientation and style is little different from a printed document. The documents tend to be static and take little advantage of computational resources that might be available. Recent work, Gentleman and Temple Lang (2003), suggests a methodology and basic infrastructure that can be used to publish documents in a substantially different way. Their approach is suitable for the publication of papers whose message relies on computation. Stated quite simply, Gentleman and Temple Lang (2003) propose a paradigm where documents are mixtures of code and text. Such documents may be self-contained or they may be a component of a compendium which provides the infrastructure needed to provide access to data and supporting software. These documents, or compendiums, can be processed in a number of different ways. One transformation will be to replace the code with its output -- thereby providing the familiar, but limited, static document. In this paper we apply these concepts to a seminal paper in bioinformatics, namely The Molecular Classification of Cancer, Golub et al (1999). The authors of that paper have generously provided data and other information that have allowed us to largely reproduce their results. Rather than reproduce this paper exactly we demonstrate that such a reproduction is possible and instead concentrate on demonstrating the usefulness of the compendium concept itself.

Journal Article↗
PubMed2004

A simple method for extracting DICOM images from a magnetooptic disk.

OBJECTIVE: Our objective was to develop a simple and easy-to-use method to extract DICOM images from magnetooptic (MO) disks to the computer desktop for research purposes. CONCLUSION: The method we developed allows users to extract DICOM images directly from MO disks to a PC desktop. The hardware component that we used is commercially available and is plug-and-play. The system is lower in cost than a clinical workstation. Users do not need to have special computer skills to use our method. DICOM images can be transferred directly from the MO disks to computer desktop folders using drag-and-drop. In our implementation, we store the DICOM files in a shared folder in our hospital network, so users can access the data from their office or research computers.

Humans↗
PubMedDate not supplied

A survey of medical informatics in Belgium.

The Belgian Society for Medical Informatics (MIM) organized a survey in 1986 in order to assess the present state of development of medical informatics in Belgium. Questionnaires were sent to hospitals, laboratories, private practitioners and pharmacists, as well as to social security organizations and software industries. The response rate was higher in hospitals (93%) than in any other category. Results showed a large number of computerized hospitals (93% of general acute care hospitals and 91% of psychiatric hospitals). There has been a sharp increase (+ 15%) in computerization of the admission, accounting and billing procedures since 1985, most likely in relation with administrative rules issued by the Belgian Government. The same trend (+ 20%) has been observed for computer applications in clinical laboratories, between 1984 and 1985. There is almost one computer terminal for ten beds in the hospitals with more than 200 beds in 1986. This figure exemplifies the present trend to on-line access to data. Computerized instrumental aids to medicine such as text processing, imaging or computerized interpretation of signals have known a rapid extension during recent years, although less comprehensive than administrative applications in hospitals and in social security organizations. The present state of other applications in medicine (general practice, pharmacy, etc.) was more difficult to assess as those information systems remain more pinpointed. In all medical fields, there appears to be a new rise in computer programs offered by software companies.

Belgium↗
PubMedDate not supplied

PACS in practice: the status of the PACS project at the St. Radboud University Hospital. Part B. A digital image archive: information analysis and development.

In accordance with the bottom-up approach in the field of the Picture Archiving and Communication System (PACS), a pilot study was performed with regard to the archiving of digital diagnostic images. A prototype has been developed to determine what information has to be stored in the digital archive and what requirements the users have in accessing these data. Firstly an organization analysis of the department of diagnostic radiology with respect to the archiving of images was performed. A variant of the ISAC method was used for this purpose. This resulted in a set of activity diagrams. Thereafter an information analysis was performed according to the Nijssen Informal Analysis Method (NIAM). This resulted in a Conceptual Schema (CS). Two other prototypes of relational Image Database Management Systems (IDBMS) are described and a description of a general modular structure of an IDBMS is given. By means of a Prototype of a Digital Archive (PDA) the department of diagnostic radiology was shown what might be expected from a digital archive and how the information will be presented to the users.

Database Management Systems↗
PubMedDate not supplied

PACS in practice: on-line communications in daily routine.

After a preparatory phase in which a software link was realized, on-line communications between a diagnostic reporting console and a computed tomography (CT) apparatus were set-up. Two specific groups of CT investigations were selected to be diagnosed in a 'digital' as well as a 'conventional' manner. The 'digital' diagnosis implies medical as well as organizational aspects. The latter will be illustrated by an organization study based on activity diagrams performed to set-up a prototype digital archive (PDA). The PDA was developed to determine the information to be stored in a digital archive and the requirements that users have in accessing image data and corresponding attributes. First experiences with respect to the organizational aspects of this clinical picture archiving and communication systems (PACS) project, in which on-line communications are used in daily routine, will be presented.

Computer Communication Networks↗
PubMedDate not supplied

Application of database systems in diabetes care.

The St Vincent Declaration includes a commitment to continuous quality improvement in diabetes care. This necessitates the collection of appropriate information to ensure that diabetes services are efficient, effective and equitable. The quantity of information, and the need for rapid access, means that this must be computer-based. The choice of architecture and the design of a database for diabetes care must take into account available equipment and operational requirements. Hardware topology may be determined by the operating system and/or netware software. An effective database system will include: user-friendliness, rapid but secure access to data, a facility for multiple selections for analysis and audit, the ability to be used as part of the patient consultation process, the ability to interface or integrate with other applications, and cost efficiency. An example of a clinical information database for diabetes care, Diamond, is described.

Computer Communication Networks↗
PubMedDate not supplied

The Electronic Primary Care Research Network (ePCRN): a new era in practice-based research.

The electronic Primary Care Research Network (ePCRN) is an electronic infrastructure that facilitates the conduct of randomized controlled trials (RCTs) in primary care and promotes the translation of research findings into practice. It provides a highly secure, Internet-based electronic infrastructure that will enable primary care practices anywhere in the United States to link with researchers in academic centers or the National Institutes of Health (NIH) to facilitate recruitment, entry, and follow-up of participants in multidisciplinary RCTs. The ePCRN also establishes a standardized clinic-based registry using distributed database technology to promote the translation of research findings into practice and to facilitate the process of clinical trials recruitment. The overall goals of the ePCRN are to provide the ability to perform large national collaborative studies throughout the United States, improve efficiency and reduce costs for individual trials, provide easier access for data retrieval and analysis, and involve primary care practices in the discovery and the translation of research findings into practice.

Databases as Topic↗