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PubMedDate not supplied

The Minnesota Prenatal Care Coordination Project: successes and obstacles.

The Minnesota Prenatal Care Coordination Project was a statewide effort to present systematically education and technical support to providers as they implemented the Minnesota Prenatal Care Initiative for expanded services to high-risk women. Educational methods included holding 12 regional workshops throughout the State, one-to-one contacts by nurse consultants, and newsletters and a guidebook (manual) were distributed to reach community providers. Analysis of the implementation was conducted using site visits, interviews with providers, and reviews of medical records, claims data, and other project documents. Successes in the first year were a twofold increase in the numbers of Medicaid-enrolled women who received risk assessment and enhanced services, more than one-third increase in provider participation, greater collaboration among multidisciplinary providers at the community level, and improved communication between State and local health care agencies. Obstacles included provider resistance to changes in practice, dissatisfaction with the enhanced services package and level of reimbursement, and problems with implementation protocols. The project demonstrated that prenatal care providers will change; they will improve practices and collaboration as a result of personalized education and support.

Female↗
PubMed1991

[Digital luminescence radiography. Part 1: Basic principle, technical execution and clinical use].

Digital luminescence radiography (DLR) is a new technique in projection radiography, which enables the production of plain X-ray images and motion tomographies with high quality, and is suitable for digital image management. With this procedure the X-ray image produced by conventional roentgen devices is temporarily stored on a reusable photostimulable storage phosphor screen which is characterized by a wide dynamic range. A laser beam scans the exposed phosphor screen and recovers the stored X-ray information as photostimulated luminescence radiation. A photomultiplier converts the emitted light into electrical signals. After normalization and digitization the signals are transmitted to an image processor. The stored digital image can be individually processed and displayed, digitally archived or transferred to any location. The technique is described in two following papers. Part 1 covers the basic principle of the system and the technical implementation of the data acquisition with its advantages and disadvantages as compared with conventional film/screen radiography.

Equipment Design↗
PubMed2000

Quality assurance issues concerning Healthcare Information Systems Project development.

The quality of the Healthcare Information System (HIS) product refers three major aspects: technical, use and organisational quality. The product quality is the result of the development process and from this perspective it must be considered from the early stages including terms of reference definition and procurement of goods and services. The issues investigated in this paper are concerning the possibilities of extending the view upon HIS projects quality by integrating the control instruments in an analytical frame covering both product and process aspects.

Humans↗
PubMed2004

Dose-dependent transitions in mechanisms of toxicity.

Scientists and decision makers from all sectors agree that risk assessments should be based on the best available science. Several years ago, the Health and Environmental Sciences Institute (HESI), a global branch of the International Life Sciences Institute (ILSI), identified the need for better scientific understanding of dose-dependent transitions in mechanisms of toxicity as one avenue by which the best and latest science can be integrated into the decision making process. In July 2001, the HESI Project Committee on Dose-Dependent Transitions in Mechanisms of Toxicity established a group of academic, government, and industry scientists to engage in active technical discourse on the issue of dose-dependent transitions in mechanisms of toxicity. Over the next 18 months, case studies were examined. These case studies included acetaminophen, butadiene, ethylene glycol, formaldehyde, manganese, methylene chloride, the peroxisome proliferator-activated receptor, progesterone/hydroxyflutamide, propylene oxide, vinyl acetate, vinyl chloride, vinylidene chloride, and zinc (Slikker, W., Jr., Andersen, M.E., Bogdanffy, M.S., Bus, J.S., Cohen, S.D., Conolly, R.B., David, R.M., Doerrer, N.G., Dorman, D.C., Gaylor, D.W., Hattis, D., Rogers, J.M., Setzer, R.W., Swenberg, J.A., Wallace, K., 2004. Dose-dependent transitions in mechanisms of toxicity: case studies. Toxicol. Appl. Pharmacol. 201(3), 226-294 (this issue)). The HESI Project Committee sponsored two technical workshops in 2003. The first of these workshops took place on February 12-13, 2003, and was co-sponsored by the Agency for Toxic Substances and Disease Registry, the American Chemistry Council, the National Institute of Environmental Health Sciences, the Society of Toxicology, and the U.S. Environmental Protection Agency. Additional support was provided by Health Canada. Invited experts from government, academia, and industry provided scientific perspectives and recommendations at the workshop. The purpose of the workshop was to examine approaches to dose-response analysis, learn from the case study examples, and gather feedback from invited participants on the impact of dose-dependent transitions on the risk assessment process. The second forum consisted of a workshop in March 2003 at the Society of Toxicology Annual Meeting in Salt Lake City, UT. This paper addresses the issues discussed at both workshops, and presents the consensus conclusions drawn by expert participants.

Animals↗
PubMed2001

Developing indicators for emergency medical services (EMS) system evaluation and quality improvement: a statewide demonstration and planning project.

BACKGROUND: The state of California, like every other state, has no system for assessing the quality of prehospital emergency medical services (EMS) care. As part of a statewide project, a process was designed for the evaluation and quality improvement (QI) of EMS in California. Local EMS agency (LEMSA) representatives made a commitment to submit data from both the providers and the hospitals they work with. INDICATOR SELECTION AND DEVELOPMENT: For conditions such as cardiac chest complaints, standardized indicators had already been developed, but for many other areas of interest there was either little literature or little consensus in the literature. Definitional differences were often linked to local-practice protocol differences. A related comparison challenge lay in the fact that care protocols may differ across systems. Some aspects of care may not be offered at all, which may reflect resource shortages or variable medical direction. DATA COLLECTION PROCEDURES: Each indicator was precisely defined, and definition sheets and data troubleshooting report forms were provided to participants in three data-collection rounds. Participants were given 1 month to collect the data, which consisted of summary-level elements (for example, average time to defibrillation for all patients 15 years or older who received defibrillation in 1998). Data were then aggregated, analyzed, and prepared for display in graphs and tables. ACCESS AND MEASUREMENT ISSUES: Numerous data collection problems were encountered. For example, not all participants could actually access data that they thought would be available. Linking data on patients as they travel through the continuum of EMS care (dispatch, field, hospital) and linking EMS data to hospital outcomes was also difficult. Yet even when data were easily available, challenges arose. The need for specificity, the potential misfit between definitions and the available data, and the challenges of data retrieval remained salient for the duration of the project and made cross-LEMSA and cross-provider comparison problematic. RECOMMENDATIONS AND LESSONS LEARNED: The project led to formal policy recommendations regarding development of a state-defined minimum data set of structure, process, and outcome indicators and their associated data elements; provision in the minimum data set for both local-level and statewide indicators; and provision of technical assistance at the local-provider level. EPILOGUE: Since the project's conclusion in June 2000, many regional and local EMS groups have begun to collect data on indicators. Many of the project's recommendations have been incorporated into the work plan of the state's System Review and Data Committee.

Adult↗
PubMed1976

[International strategies in medical education: technical assistance and technical cooperation].

This article reviews the evolution of international activity for national development in general and for medical education in particular. The concepts of traditional technical aid and the new method of technical cooperation are studied. That method appeared just before the beginning of this decade as a response to needs existing at the time to coordinate development with the emerging international economic order. This article discusses the emphasis given to strategy in this new concept of international activity. Strategy, in this sense, consists of a clear definition of goals and objectives by the countries themselves, mobilization of local resources, and full participation of national personnel in all phases of the process. The projects promoted by the Pan American Health Organization in applying technical cooperation to the field of health manpower training are discussed. Such activities include: coordinating the above mentioned training, providing overall support for institutional development, training professors and administrators, developing educational technology, creating and developing a network of biomedical information, developing social sciences as applied to medicine, and encouraging medical, epidemiological, social, and operational research.

Education, Medical↗
PubMed1987

The graduate technical assistance program: an alternative to traditional training for health administration students.

This paper presents a discussion of current modes of field training for graduate students in health services administration and details the educational goals and structural elements of the Graduate Technical Assistance Program (GTAP) at Arizona State University. The program's unique features include an emphasis on provider defined problems and projects, timely response to these problems by students, and the involvement of students, throughout their training, in consultant relationships with providers. The program also places the student in a new set of collaborative relationships with program faculty. The profiles of the 21 organizations requesting technical assistance, the skills required for project completion, and the range of projects are detailed.

Arizona↗
PubMed2002

Planning an enterprisewide PACS: the Centre Hospitalier de l'Université de Montréal experience.

This exhibit reflects the experience accumulated in our 3-year process at the Centre Hospitalier de l'Université de Montréal, beginning with the planning of the project and culminating in the choice of a PACS provider. Although the technical requirements represent a major consideration, organizational and functional aspects of PACS planning and implementation are discussed. The purpose is not to single out a particular PACS vendor, since the local conditions surrounding each PACS project (both hospital and vendor specific) are variable. Successful implementation of a PACS in any institution requires adequate planning and considerable foresight. We describe our approach and discuss the difficulties and pitfalls encountered during our planning phase that led up to implementation.

Health Planning↗
PubMed1986

Evaluation of international population projections: lessons and experiences.

Global and regional population projections produced by the United Nations are evaluated and compared with actual population estimates. While general observations pertaining to the global level are made, the focus is on Latin America for selected years from 1950 to 1980. It is found that "the quality of population projections improved since 1950. In addition, short-term projections are found to be relatively more accurate than those for the long-term.... In the medium- or long-term projections, at least in the Latin American case, the assumptions regarding mortality were far from the real situation. The important factors in the projections are found to be in the order of base population, fertility and mortality."

Americas↗
PubMed1986

The current situation, aspects, and projects concerning nuclear medicine software in Europe.

Since the 1984 Congress of the Society of Nuclear Medicine-Europe in Helsinki, the "Task Group for European Nuclear Medicine Software Cooperation", which became the "Joint ENMS/SNME Nuclear Medicine Software Task Group" in London in 1985, has focused attention on establishing a new COST project (European Cooperation in the Field of Scientific and Technical Research) (COST 1981) in the field of nuclear medicine Software. On 20 March 1986, the mandate was finally approved officially by the COST Committee of Senior Officials in Brussels (see Editorial in this issue). The problems, content, and objectives of specific items and ideas regarding NM software that have been publicized at the European level are dealt with here. The reader actively interested in NM software is encouraged to participate in the COST framework and forum, in order to avoid duplication of effort and to utilize resources more efficiently by coordinating activities in nuclear medicine in Europe.

Artificial Intelligence↗
PubMed2005

Present and future of rapid and/or high-throughput methods for nucleic acid testing.

BACKGROUND: Behind the success of 'completing' the human genome project was a more than 30-year history of technical innovations for nucleic acid testing. METHODS: Discovery of specific restriction endonucleases and reverse transcriptase was followed shortly by the development of the first diagnostic nucleic acid tests in the early 1970s. Introduction of Southern, Northern and dot blotting and DNA sequencing later in the 1970s considerably advanced the diagnostic capabilities. Nevertheless, it was the discovery of the polymerase chain reaction (PCR) in 1985 that led to an exponential growth in molecular biology and the introduction of practicable nucleic acid tests in the routine laboratory. The past two decades witnessed a continuing explosion of technological innovations in molecular diagnostics. In addition to classic PCR and reverse transcriptase PCR, numerous variations of PCR and alternative amplification techniques along with an ever-increasing variety of detection chemistries, closed tube (homogeneous) assays, and automated systems were developed. Discovery of real-time quantitative PCR and the development of oligonucleotide microarrays, the 'DNA chip', in the 1990s heralded the beginning of another revolution in molecular biology and diagnostics that is still in progress.

Animals↗